Key Point:

• Prior therapy with statins appears to prevent the development of severe sepsis in critically ill patients.

ORLANDO, FLA—Severe sepsis is a leading cause of death in the ICU, and its incidence is rising. Because sepsis involves a complex series of conflicting pro-inflammatory and anti-inflammatory mechanisms, virtually all attempts at treating sepsis with a single therapeutic agent have failed. Perhaps as a consequence, few efforts to prevent sepsis other than routine infection-control procedures have been undertaken.

“Primary prevention of sepsis has never been attempted,” said Yaniv Almog, MD, at the annual meeting of the Society of Critical Care Medicine.[1] This may soon change, however. Dr. Almog and his colleagues from Soroka University Medical Center in Beer Sheva, Israel, have observed that patients who were receiving lipid-lowering therapy with statins rarely developed severe sepsis.

To confirm their observation, the investigators conducted a prospective, observational cohort study of 321 severely ill patients: 68 of these patients had been taking statins before their illness, and 253 had not. The rates of severe sepsis, organ failure, and mortality at 28 days were all significantly lower in the statin group (Figure).

Why do statins appear to improve outcomes in critical illness? “Statins have anti-inflammatory [and immunomodulatory] properties, independent of their lipid-lowering abilities,” Dr. Almog explained. They may interfere with the first step in the activation of the inflammatory cascade, so that inflammation and endothelial dysfunction do not occur.

In addition, statins significantly decrease the production of C-reactive protein, which, along with interleukin-6 and other mediators, is part of the acute-phase response in the pathogenesis of sepsis. Dr. Almog concluded that if his team’s recent findings are confirmed, statins could be used as primary prevention to reduce sepsis-related ICU admissions.

—Gale Jurasek

Reference
1. Almog Y. Prior statin therapy protects against severe sepsis. Presented at: annual meeting of the Society of Critical Care Medicine; February 22, 2004; Orlando, Fla.

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