Impact of previous statin and angiotensin II receptor blocker use on mortality in patients hospitalized with sepsis

Study Objective. To examine the effect of previous outpatient use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and/or angiotensin II receptor blockers (ARBs) on 30-day mortality in patients hospitalized with sepsis. Design. Retrospective national cohort study. Data Source. Department of Veterans Affairs (VA) national patient care and pharmacy databases. Patients. A total of 3018 patients who were hospitalized with sepsis in fiscal year 2000, had at least I year of previous VA outpatient care, and had at least one active and filled VA prescription within 90 days of admission. Measurements and Main Results. The primary outcome was 30-day mortality. The primary analysis was a multilevel model with hospital as a random effect and control variables that included comorbid conditions, demographics, and other drugs. Among the 3018 patients hospitalized with sepsis, mean age was 74.4 years, 2975 (98.6%) were male, and 811 (26.9%) died within 30 days of admission. Regarding prescription drug use, 480 patients (15.9%) were taking statins and 107 (3.5%) were taking ARBs. After adjusting for potential confounders, statin use (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.36-0.64) and ARB use (OR 0.42, 95% CI 0.24-0.76) were significantly associated with decreased 30-day mortality. Conclusions. Use of statins and/or ARBs before admission was associated with decreased mortality in patients hospitalized with sepsis. Further research is needed to determine if these drugs might be started on admission for those with sepsis.