Gupta R et al. (2007) Statin use and hospitalization for sepsis in patients with chronic kidney disease. JAMA 297: 1455–1464

Sepsis is a major cause of death in patients on dialysis. Studies have indicated that statins, which are widely used to treat and prevent cardiovascular disease, might also have utility in preventing and reducing the severity of sepsis. As part of the recent prospective, multicenter CHOICE study, investigators determined whether statin use was associated with a decrease in the incidence of sepsis in patients with chronic kidney disease on dialysis.

Between October 1995 and June 1998, the study enrolled 1,041 patients aged >17 years who had started maintenance outpatient dialysis in the previous 3 months. Patients were followed up until January 2005. The primary outcome was hospitalization for sepsis.

At baseline, 14% of patients were taking statins. During follow-up, there were 303 hospitalizations for sepsis in 165 patients (after a mean of 3.4 years). Statin users were 63% less likely to be hospitalized for sepsis than were nonusers (crude sepsis incidence rates 41/1,000 patient-years vs 110/1,000 patient-years, respectively; P <0.001). Even after adjustment for demographic characteristics, dialysis modality, comorbidities and laboratory values, the risk of hospitalization for sepsis was 62% lower in statin users. When patients with a history of sepsis were excluded from the multivariate analyses, statin users were still 60% less likely to be hospitalized for sepsis. In a subcohort analysis of 214 patients matched according to their propensity to be prescribed a statin, statin users were 76% less likely to be hospitalized for sepsis than were nonusers.