Optimal statin use for prevention of sepsis in type 2 diabetes mellitus

Diabetology & Metabolic Syndrome

卷:15

Research

Yuan Tao¹  Jiaqiang Zhang¹  Mingyang Sun¹  Wan-Ming Chen²  Szu-Yuan Wu³ 

[1] Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China;

[2] Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan;Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan;

[3] Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan;Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan;Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan;Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan;Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, 265, Yilan County, Taiwan;Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan;Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan;Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;Department of Management, College of Management, Fo Guang University, Yilan, Taiwan;

关键词: T2DM;    Dose-dependent;    Statins;    Intensity;    Sepsis;   

DOI  :  10.1186/s13098-023-01041-w

 received in 2023-02-15, accepted in 2023-03-24,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeTo investigate the dose-dependent protective effects of statins, specific classes of statins, and different intensities of statin use on sepsis risk in patients with type 2 diabetes mellitus (T2DM).MethodsWe included patients with T2DM aged  ≥ 40 years. Statin use was defined as the use of statin on most days for  > 1 months with a mean statin dose of  ≥ 28 cumulative defined daily doses (cDDDs) per year (cDDD-year). An inverse probability of treatment-weighted Cox hazard model was used to investigate the effects of statin use on sepsis and septic shock while considering statin use status as a time-dependent variable.ResultsFrom 2008 to 2020, a total of 812 420 patients were diagnosed as having T2DM. Among these patients, 118,765 (27.79%) statin nonusers and 50 804 (12.03%) statin users developed sepsis. Septic shock occurred in 42,755 (10.39%) individuals who did not use statins and 16,765 (4.18%) individuals who used statins. Overall, statin users had a lower prevalence of sepsis than did nonusers. The adjusted hazard ratio (aHR) of statin use was 0.37 (95% CI 0.35, 0.38) for sepsis compared with no statin use. Compared with the patients not using statins, those using different classes of statins exhibited a more significant reduction in sepsis, with aHRs (95% CIs) of sepsis being 0.09 (0.05, 0.14), 0.32 (0.31, 0.34), 0.34 (0.32, 0.36), 0.35 (0.32, 0.37), 0.37 (0.34, 0.39), 0.42 (0.38, 0.44), and 0.54 (0.51, 0.56) for pitavastatin, pravastatin, rosuvastatin, atorvastatin, simvastatin, fluvastatin, and lovastatin use, respectively. In the patients with different cDDD-years of statins, multivariate analysis indicated a significant reduction in sepsis, with aHRs of 0.53 (0.52, 0.57), 0.40 (0.39, 0.43), 0.29 (0.27, 0.30), and 0.17 (0.15, 0.19) for Q1, Q2, Q3, and Q4 cDDD-years (P for trend < 0.0001). The optimal daily statin dose of 0.84 DDD was associated with the lowest aHR. Similar trends of higher cDDD-year and specific statin types use were associated with a decrease in septic shock when compared to statin non-users.ConclusionOur real-world evidence demonstrated that the persistent use of statins reduced sepsis and septic shock risk in patients with T2DM and a higher cDDD-year of statin use was associated with an increased reduction of sepsis and septic shock risk in these patients.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 3