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Association between Preoperative Statin Therapy and Postoperative Infectious Complications in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Published online by Cambridge University Press:  02 January 2015

Imad M. Tleyjeh ,
Faisal A. Alasmari ,
Aref A. Bin Abdulhak ,
Muhammad Riaz ,
Musa A. Garbati ,
Patricia J. Erwin ,
Tarek Kashour ,
Mouaz H. Al-Mallah  and
Larry M. Baddour
Imad M. Tleyjeh*
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
Faisal A. Alasmari
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Aref A. Bin Abdulhak
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Muhammad Riaz
Affiliation:
Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia
Musa A. Garbati
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Patricia J. Erwin
Affiliation:
Mayo Medical Library, Mayo Clinic, Rochester, Minnesota
Tarek Kashour
Affiliation:
Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia
Mouaz H. Al-Mallah
Affiliation:
King Fahad National Guard Hospital, Riyadh, Saudi Arabia; andWayne State University, Detroit, Michigan
Larry M. Baddour
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Research and Scientific Publication Center, King Fahd Medical City, Aldabab Street, Riyadh 11525, PO Box 59046, Riyadh, Saudi Arabia ([email protected][email protected])
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Abstract

Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections. We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery. We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64–1.01]; P = .06; I2 = 75%). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted.

Type
Review Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1143 - 1151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Northrup, WF III, Emery, RW, Nicoloff, DM, Lillehei, TJ, Holter, AR, Blake, DP. Opposite trends in coronary artery and valve surgery in a large multisurgeon practice, 1979–1999. Ann Thorac Surg 2004;77(2):488–495.CrossRefGoogle Scholar
2.Ghotkar, SV, Grayson, AD, Fabri, BM, Dihmis, WC, Pullan, DM. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting. J Cardiothorac Surg 2006;1:14.Google Scholar
3.Fowler, VG Jr, O'Brien, SM, Muhlbaier, LH, Corey, GR, Ferguson, TB, Peterson, ED. Clinical predictors of major infections after cardiac surgery. Circulation 2005;112(suppl 9):I358–I365.Google Scholar
4.Janda, S, Young, A, Fitzgerald, JM, Etminan, M, Swiston, J. The effect of statins on mortality from severe infections and sepsis: a systematic review and meta-analysis. J Crit Care 2010;25(4):656.e7–656.e22.CrossRefGoogle ScholarPubMed
5.Tleyjeh, IM, Kashour, T, Hakim, FA, et al.Statins for the prevention and treatment of infections: a systematic review and meta-analysis. Arch Intern Med 2009;169(18):1658–1667.Google Scholar
6.Kopterides, P, Falagas, ME. Statins for sepsis: a critical and updated review. Clin Microbiol Infect 2009;15(4):325–334.Google Scholar
7.Davignon, J. Beneficial cardiovascular pleiotropic effects of statins. Circulation 2004;109(23suppl 1):III39–III43.Google Scholar
8.Ray, KK, Cannon, CP. The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes. J Am Coll Cardiol 2005;46(8):1425–1433.CrossRefGoogle ScholarPubMed
9.Catron, DM, Lange, Y, Borensztajn, J, Sylvester, MD, Jones, BD, Haldar, K. Salmonella enterica serovar Typhimurium requires nonsterol precursors of the cholesterol biosynthetic pathway for intracellular proliferation. Infect Immun 2004;72(2):1036–1042.Google Scholar
10.del Real, G, Jimenez-Baranda, S, Mira, E, et al.Statins inhibit HIV-1 infection by down-regulating rho activity. J Exp Med 2004;200(4):541–547.Google Scholar
11.Potena, L, Frascaroli, G, Grigioni, F, et al.Hydroxymethyl-glutaryl coenzyme a reductase inhibition limits cytomegalovirus infection in human endothelial cells. Circulation 2004;109(4):532–536.CrossRefGoogle ScholarPubMed
12.Merx, MW, Liehn, EA, Janssens, U, et al.HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis. Circulation 2004;109(21):2560–2565.CrossRefGoogle Scholar
13.Gyetvai, A, Emri, T, Takacs, K, et al.Lovastatin possesses a fungistatic effect against Candida albicans, but does not trigger apoptosis in this opportunistic human pathogen. FEMS Yeast Res 2006;6(8):1140–1148.CrossRefGoogle Scholar
14.Chin, NX, Weitzman, I, Della-Latta, P. In vitro activity of fluvastatin, a cholesterol-lowering agent, and synergy with flucanazole and itraconazole against Candida species and Cryptococcus neoformans. Antimicrob Agents Chemother 1997;41(4):850–852.Google Scholar
15.Macreadie, IG, Johnson, G, Schlosser, T, Macreadie, PI. Growth inhibition of Candida species and Aspergillus fumigatus by statins. FEMS Microbiol Lett 2006;262(1):9–13.Google Scholar
16.Coleman, CI, Lucek, DM, Hammond, J, White, CM. Preoperative statins and infectious complications following cardiac surgery. Curr Med Res Opin 2007;23(8):1783–1790.Google Scholar
17.Clark, LL, Ikonomidis, JS, Crawford, FA Jr, et al.Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study. J Thorac Cardiovasc Surg 2006;131(3):679–685.Google Scholar
18.Daneman, N, Thiruchelvam, D, Redelmeier, DA. Statin use and the risk of surgical site infections in elderly patients undergoing elective surgery. Arch Surg 2009;144(10):938–945.Google Scholar
19.Mohamed, R, McAlister, FA, Pretorius, V, et al.Preoperative statin use and infection after cardiac surgery: a cohort study. Clin Infect Dis 2009;48(7):e66–e72.Google Scholar
20.Borger, MA, Seeburger, J, Walther, T, et al.Effect of preoperative statin therapy on patients undergoing isolated and combined valvular heart surgery. Ann Thorac Surg 2010;89(3):773–780.CrossRefGoogle Scholar
21.Subramaniam, K, Koch, CG, Bashour, A, et al.Preoperative statin intake and morbid events after isolated coronary artery bypass grafting. J Clin Anesth 2008;20(1):4–11.Google Scholar
22.Stroup, DF, Berlin, JA, Morton, SC, et al.Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283(15):2008–2012.Google Scholar
23.Wells, G, Shea, B, O'Connell, D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute website, http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 2009. Accessed August 31, 2011.Google Scholar
24.DerSimonian, R, Laird, N. Meta-analysis in clinical trials. Control Clin Trials 1986;7(3):177–188.CrossRefGoogle ScholarPubMed
25.Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560.Google Scholar
26.Egger, M, Smith, DG, Schneider, M, Minder, C. Bias in metaanalysis detected by a simple, graphical test. BMJ 1997;315(7109):629–634.Google Scholar
27.Ali, IS, Buth, KJ. Preoperative statin use and outcomes following cardiac surgery. Int J Cardiol 2005;103(1):12–18.Google Scholar
28.Tleyjeh, I, Alasmari, F, Riaz, M, et al.A clinical prediction rule of deep sternal wound infections after coronary artery bypass graft surgery: a population-based cohort study, 1993 to 2008. Clin Microbiol Infect 2012;18(suppl S3):79.Google Scholar
29.Ali, IS, Buth, KJ. Impact of preoperative statin use on sepsis and deep sternal wound infection following cardiac surgery. Circulation 2005;111:e320.Google Scholar
30.Falagas, ME, Makris, GC, Matthaiou, DK, Rafailidis, PI. Statins for infection and sepsis: a systematic review of the clinical evidence. J Antimicrob Chemother 2008;61(4):774–785.Google Scholar
31.Chua, D, Tsang, RS, Kuo, IF. The role of statin therapy in sepsis. Ann Pharmacother 2007;41(4):647–652.Google Scholar
32.van den Hoek, HL, Bos, WJ, de Boer, A, van de Garde, EM. Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials. BMJ 2011;343:d7281.Google Scholar
33.Biasucci, LM, Biasillo, G, Stefanelli, A. Inflammatory markers, cholesterol and statins: pathophysiological role and clinical importance. Clin Chem Lab Med 2010;48(12):1685–1691.Google Scholar
34.Istvan, ES, Deisenhofer, J. Structural mechanism for statin inhibition of HMG-CoA reductase. Science 2001;292(5519):1160–1164.CrossRefGoogle ScholarPubMed
35.Kwak, B, Mulhaupt, F, Myit, S, Mach, F. Statins as a newly recognized type of immunomodulator. Nat Med 2000;6(12):1399–1402.Google Scholar
36.Gruenbacher, G, Gander, H, Nussbaumer, O, Nussbaumer, W, Rahm, A, Thurnher, M. IL-2 costimulation enables statin-mediated activation of human NK cells, preferentially through a mechanism involving CD56+ dendritic cells. Cancer Res 2010;70(23):9611–9620.Google Scholar
37.Tanaka, N, Abe-Dohmae, S, Iwamoto, N, Fitzgerald, ML, Yokoyama, S. HMG-CoA reductase inhibitors enhance phagocytosis by upregulating ATP-binding cassette transporter A7. Atherosclerosis 2011;217(2):407–414.Google Scholar
38.Fernandez, R, De Pedro, VJ, Artigas, A. Statin therapy prior to ICU admission: protection against infection or a severity marker? Intensive Care Med 2006;32(1):160–164.Google Scholar
39.Hillis, LD, Smith, PK, Anderson, JL, et al.2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;124(23):e652–e735.Google Scholar
40.Arnold, SV, Spertus, JA, Tang, F, et al.Statin use in outpatients with obstructive coronary artery disease. Circulation 2011;124(22):2405–2410.Google Scholar