Background

Disseminated Intravascular Coagulation (DIC) is a syndrome of dysregulated coagulation. Patients with sepsis are at increased risk for DIC. HMG-CoA Reductase Inhibitors (Statins) are primarily used as lipid-lowering agents; however, studies have suggested statins may possess anti-inflammatory, antithrombotic, anticoagulant, and endothelial stabilizing properties. These mechanisms may oppose those that underlie the pathogenesis of septic DIC.

Methods

To evaluate whether statins may be protective against the development of DIC, we conducted a multi-center, retrospective case-control study where 86,638 critically ill patients admitted to the ICU with sepsis, severe sepsis or septic shock were identified during a 3-year period. Patients who developed DIC during their hospitalization were identified and stratified by whether they received a statin or not during their hospitalization. Odds ratios for development of DIC was calculated by composite of any statin, as well as low, moderate, and high intensity statins.

Results

2236 patients would develop DIC compared to 84,402 who did not. The use of any statin was associated with a reduced likelihood for developing DIC (odds ratio [OR], 0.69; 95% CI, 0.61–0.78). This was observed with use of both moderate (OR, 0.64; 95% CI, 0.53–0.77) and high (OR, 0.72; 95% CI, 0.61–0.84) but not low intensity statins (OR, 0.84; 95% CI, 0.53–1.32).

Conclusions

The use of moderate and high intensity statins was associated with a significantly reduced odds of developing DIC in critically ill patients with sepsis. This present study may be the first to suggest that statin medications may independently reduce the frequency of DIC in critically ill patients with severe sepsis or septic shock. More research is needed to investigate the potential for this class of medication to be protective against DIC.

中文翻译：

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HMG-CoA 还原酶抑制剂可降低脓毒症患者弥散性血管内凝血的风险

背景

弥散性血管内凝血（DIC）是一种凝血失调综合征。脓毒症患者发生 DIC 的风险增加。HMG-CoA还原酶抑制剂（他汀类药物）主要用作降脂药；然而，研究表明他汀类药物可能具有抗炎、抗血栓、抗凝血和内皮稳定特性。这些机制可能会对抗脓毒症 DIC 发病机制中的机制。

方法

为了评估他汀类药物是否可以预防 DIC 的发展，我们进行了一项多中心、回顾性病例对照研究，在 3 年期间确定了 86,638 名因败血症、严重败血症或败血性休克入住 ICU 的危重患者。根据住院期间是否接受他汀类药物治疗，对住院期间发生 DIC 的患者进行识别和分层。通过任何他汀类药物以及低、中和高强度他汀类药物的组合来计算发生 DIC 的优势比。

结果

2236 名患者会患上 DIC，而没有患上 DIC 的患者则有 84,402 名。使用任何他汀类药物均可降低发生 DIC 的可能性（优势比 [OR]，0.69；95% CI，0.61–0.78）。在使用中强度（OR，0.64；95% CI，0.53-0.77）和高强度（OR，0.72；95% CI，0.61-0.84）但低强度他汀类药物（OR，0.84；95% CI， 0.53–1.32）。

结论

使用中强度和高强度他汀类药物可显着降低脓毒症危重患者发生 DIC 的几率。本研究可能是第一个表明他汀类药物可以独立降低患有严重败血症或败血性休克的危重患者的 DIC 频率的研究。需要更多的研究来调查此类药物预防 DIC 的潜力。