Statin therapy in critical illness: an international survey of intensive care physicians’ opinions, attitudes and practice

Manu Shankar-Hari,Marius Terblanche,Peter S Kruger,Damon C Scales,Stefania Di Gangi,Danny F Mcauley,Gavin D Perkins

doi:10.1186/1472-6904-12-13

Abstract

BackgroundPleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure. We conducted an international survey of intensive care physicians in Australia, New Zealand (ANZ) and United Kingdom (UK). The aims of the survey were to assess the current prescribing practice patterns, attitudes towards prescribing statin therapy in critically ill patients and opinions on the need for an interventional trial of statin therapy in critically ill patients.MethodsSurvey questions were developed through an iterative process. An expert group reviewed the resulting 26 items for face and content validity and clarity. The questions were further refined following pilot testing by ICU physicians from Australia, Canada and the UK. We used the online Smart SurveyTM software to administer the survey.ResultsOf 239 respondents (62 from ANZ and 177 from UK) 58% worked in teaching hospitals; most (78.2%) practised in ‘closed’ units with a mixed medical and surgical case mix (71.0%). The most frequently prescribed statins were simvastatin (77.6%) in the UK and atorvastatin (66.1%) in ANZ. The main reasons cited to explain the choice of statin were preadmission prescription and pharmacy availability. Most respondents reported never starting statins to prevent (65.3%) or treat (89.1%) organ dysfunction. Only a minority (10%) disagreed with a statement that the risks of major side effects of statins when prescribed in critically ill patients were low. The majority (84.5%) of respondents strongly agreed that a clinical trial of statins for prevention is needed. More than half (56.5%) favoured rates of organ failure as the primary outcome for such a trial, while a minority (40.6%) favoured mortality.ConclusionsDespite differences in type of statins prescribed, critical care physicians in the UK and ANZ reported similar prescription practices. Respondents from both communities agreed that a trial is needed to test whether statins can prevent the onset of new organ failure in patients with sepsis.

Highlights

Pleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure
The most common reason cited for choosing a particular statin from both the United Kingdom (UK) and ANZ physicians was prior use
Nearly half of respondents agreed or strongly agreed that the risks of major side effects of statins are low when prescribed in critically ill patients (UK 48.6% vs. ANZ 50.0%)

Summary

Introduction

Pleotropic effects of statins on inflammation are hypothesised to attenuate the severity of and possibly prevent the occurrence of the host inflammatory response to pathogen and infection-related acute organ failure. The estimated annual cost of treating sepsis in the United States was $16.7 billion [5], whilst the estimated cost of managing a patient with sepsis in the intensive care unit has been reported to vary between $19,000 to $28,000 [6]. Interventions such as resuscitation of patient with sepsis further adds to the management cost [7]. Testing agents with modulating effects at multiple points may be a more successful strategy [10,11,12,13,14] to prevent the onset of acute organ failure

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Results

Discussion

Conclusion