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Intensive Care Med. 2017 May;43(5):663-671. doi: 10.1007/s00134-016-4649-0. Epub 2016 Dec 21.

Statin therapy for acute respiratory distress syndrome: an individual patient data meta-analysis of randomised clinical trials.

Author information

1
Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London and Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
2
School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK.
3
Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia.
4
School of Medicine, University of Queensland, Brisbane, Australia.
5
Medical Intensive Care Unit, North Hospital, Aix-Marseille University, Marseille, France.
6
Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
7
Departments of Anesthesia and Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada.
8
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
9
Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London and Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. anthony.gordon@imperial.ac.uk.

Abstract

PURPOSE:

We performed an individual patient data meta-analysis to assess the possible benefits and harms of statin therapy in adults with acute respiratory distress syndrome (ARDS) and to investigate effects in specific ARDS subgroups.

METHODS:

We identified randomised clinical trials up to 31 October 2016 that had investigated statin therapy versus placebo in patients with ARDS. Individual patient data from each trial were compiled. Conventional two-stage meta-analyses were performed for primary and secondary outcomes, and one-stage regression models with single treatment-covariate interactions for subgroup analyses. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

RESULTS:

Six trials with a total of 1755 patients were included. For the primary outcomes, there was no significant effect of statin therapy on 28-day mortality [relative risk (RR) 1.03, 95% CI 0.86-1.23], ventilator-free days (mean difference 0.34 days, 95% CI -0.68 to 1.36) or serious adverse events (RR 1.14, 95% CI 0.84-1.53). There was a significantly increased incidence of raised serum creatine kinase or transaminase levels with statin therapy (106/879; 12.1%) versus control (78/876; 8.9%) (RR 1.40, 95% CI 1.07-1.83, p = 0.015). There were no significant treatment-covariate interactions in the predefined subgroups investigated.

CONCLUSIONS:

We found no clinical benefit from initiation of statin therapy in adult patients with ARDS, either overall or in predefined subgroups. While there was an increased incidence of raised serum creatine kinase and transaminase levels, there was no difference in serious adverse events among groups. Therefore, we do not recommend initiation of statin therapy for the treatment of ARDS.

KEYWORDS:

ALI; ARDS; Meta-analysis; Statin

PMID:
28004129
DOI:
10.1007/s00134-016-4649-0
[Indexed for MEDLINE]
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