Hospital Pharmacy - June 2018 - 155

155

McPheeters et al
Table 3. Comparison of In-Hospital Mortality in Relation to Number of Vasopressors Used.
Number of vasopressors required

In-hospital mortality (n = 131)

Number required
1
2
3

n (%)
47 (35.9)
46 (35.1)
38 (29.0)

Alive at discharge (n = 162)

P value

n (%)
119 (73.5)
31 (19.1)
12 (7.4)

<.001

Note. P values <.05 were considered statistically significant.

Table 4. Time to First Dose and Duration of Antimicrobial Use
and Characterization of Steroid Use.
Cases (n = 88)

Controls (n = 205)

Time to first dose of antimicrobial, mean (standard error)
Hours
6.1 (5.7)
10.8 (3.7)
Median (range) antimicrobial usage
Duration, days
5 (6.0)
5 (6.0)
Steroid use, n (%)
Yes
30 (34.5)
66 (32.5)

P value
.48
.85
.78

Note. P values <.05 were considered statistically significant.

Other Measures
Duration of antimicrobial therapy was a median of 5 days in
both groups (P = .85). There was no difference in time to first
dose of antimicrobial or steroid use between the 2 groups (P
= .48 and P = .78, respectively; Table 4). Patient-specific
statin exposure was as follows: atorvastatin (n = 38), lovastatin (n = 4), pravastatin (n = 12), rosuvastatin (n =12), and
simvastatin (n = 23). Ninety-two percent of statin-exposed
patients were reinitiated on statin therapy within 24 hours of
admission. Fourteen control patients (6.8%) were started on
statin therapy during their hospital stay.

Discussion
The results of this study suggest that previous statin exposure
has no impact on the duration of vasopressor therapy in
patients who present with septic shock. Previous studies have
been inconsistent regarding the effects of statin therapy on
vasopressor use. Mansur et al demonstrated a significant
increase in vasopressor-free days in patients with previous
statin exposure categorized as having severe sepsis-associated
ARDS.14 In contrast, Zechmeister et al were unable to show
any decrease in the duration of vasopressor therapy in patients
with statin continuation on admission.15 Data provided by the
current study suggest that statins do not impact the duration of
vasopressor therapy in patients presenting with septic shock.
Also significant is that the current study compared prior
statin exposure with no prior statin exposure rather than simply focusing on the continuation of statin therapy. In contrast, both Mansur et al and Zechmeister et al assessed statin
effects by comparing continuation versus noncontinuation of
statin therapy on admission.14,15 That is, these studies only

compared the short-term effects of statins by assessing statin
administration on admission. We sought to understand the
long-term effects of statin exposure. Fortunately, for the purposes of our research focus, statins were continued on admission in all but 7 of the patients in the case group. As a result,
we were able to compare prior statin exposure and continuation on admission with no statin exposure, with no significant differences found. Both the long-term and short-term
effects of statins appear to suggest no medical benefit from
augmenting the duration of vasopressor requirement in
patients presenting with septic shock.
Not surprisingly, patients in the statin group were more
likely to have CAD, prior stroke, and DM. Statins thus do not
seem to provide a protective effect in septic shock for those
patients who have an indication for use. Heterogeneity
between the 2 groups could possibly have contributed to a
lack of significant outcomes. Future studies with more
homogenous groups in regard to age, gender, smoking status,
and preexisting conditions could potentially further refine
our knowledge regarding the impact of statins on the duration of vasopressor therapy.
Recently the Journal of the American Medical
Association published Sepsis-3, a new definition of sepsis
and septic shock. This new definition asserts that sepsis is
defined by life-threatening organ dysfunction caused by a
dysregulated host response to infection. Previous definitions of sepsis have focused almost exclusively on inflammation. This is a concept that has not been shown to be
sufficiently sensitive or specific.17 More recent data now
recognize that sepsis involves activation of both pro- and
anti-inflammatory responses as well as other nonimmunologic pathways such as cardiovascular dysfunction and
alterations in coagulation.17,18 Statins have been shown to
have pleiotropic anti-inflammatory effects. The positive
outcomes these agents have allegedly demonstrated in sepsis and septic shock have been attributed to these properties. The findings of no difference in this study in any
outcome measure including duration of vasopressor therapy, mortality, length of ICU or hospital stay, and end-organ
dysfunction support the theory behind the new sepsis definition, which places less emphasis on the inflammatory
cascade in response to infection.
This study was limited by its retrospective design and use
of ICD-9 codes to identify the study population. Another
limitation was the time to first dose of antimicrobials in each



Table of Contents for the Digital Edition of Hospital Pharmacy - June 2018

Ed Board
TOC
USP <800>
Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Zoster Vaccine Recombinant, Adjuvanted
Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
New Medications in the Treatment of Nonalcoholic Steatohepatitis
One Chance for Your Best First Impression: Tips for New Pharmacists
Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Intravenous Push Administration of Antibiotics: Literature and Considerations
The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - Cover1
Hospital Pharmacy - June 2018 - Cover2
Hospital Pharmacy - June 2018 - Ed Board
Hospital Pharmacy - June 2018 - TOC
Hospital Pharmacy - June 2018 - 131
Hospital Pharmacy - June 2018 - USP <800>
Hospital Pharmacy - June 2018 - 133
Hospital Pharmacy - June 2018 - Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Hospital Pharmacy - June 2018 - 135
Hospital Pharmacy - June 2018 - Zoster Vaccine Recombinant, Adjuvanted
Hospital Pharmacy - June 2018 - 137
Hospital Pharmacy - June 2018 - 138
Hospital Pharmacy - June 2018 - 139
Hospital Pharmacy - June 2018 - 140
Hospital Pharmacy - June 2018 - 141
Hospital Pharmacy - June 2018 - Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
Hospital Pharmacy - June 2018 - 143
Hospital Pharmacy - June 2018 - 144
Hospital Pharmacy - June 2018 - 145
Hospital Pharmacy - June 2018 - New Medications in the Treatment of Nonalcoholic Steatohepatitis
Hospital Pharmacy - June 2018 - 147
Hospital Pharmacy - June 2018 - One Chance for Your Best First Impression: Tips for New Pharmacists
Hospital Pharmacy - June 2018 - 149
Hospital Pharmacy - June 2018 - 150
Hospital Pharmacy - June 2018 - 151
Hospital Pharmacy - June 2018 - Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Hospital Pharmacy - June 2018 - 153
Hospital Pharmacy - June 2018 - 154
Hospital Pharmacy - June 2018 - 155
Hospital Pharmacy - June 2018 - 156
Hospital Pharmacy - June 2018 - Intravenous Push Administration of Antibiotics: Literature and Considerations
Hospital Pharmacy - June 2018 - 158
Hospital Pharmacy - June 2018 - 159
Hospital Pharmacy - June 2018 - 160
Hospital Pharmacy - June 2018 - 161
Hospital Pharmacy - June 2018 - 162
Hospital Pharmacy - June 2018 - 163
Hospital Pharmacy - June 2018 - 164
Hospital Pharmacy - June 2018 - 165
Hospital Pharmacy - June 2018 - 166
Hospital Pharmacy - June 2018 - 167
Hospital Pharmacy - June 2018 - 168
Hospital Pharmacy - June 2018 - 169
Hospital Pharmacy - June 2018 - The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Hospital Pharmacy - June 2018 - 171
Hospital Pharmacy - June 2018 - 172
Hospital Pharmacy - June 2018 - 173
Hospital Pharmacy - June 2018 - 174
Hospital Pharmacy - June 2018 - 175
Hospital Pharmacy - June 2018 - 176
Hospital Pharmacy - June 2018 - Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Hospital Pharmacy - June 2018 - 178
Hospital Pharmacy - June 2018 - 179
Hospital Pharmacy - June 2018 - 180
Hospital Pharmacy - June 2018 - 181
Hospital Pharmacy - June 2018 - 182
Hospital Pharmacy - June 2018 - 183
Hospital Pharmacy - June 2018 - 184
Hospital Pharmacy - June 2018 - 185
Hospital Pharmacy - June 2018 - 186
Hospital Pharmacy - June 2018 - 187
Hospital Pharmacy - June 2018 - Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Hospital Pharmacy - June 2018 - 189
Hospital Pharmacy - June 2018 - 190
Hospital Pharmacy - June 2018 - 191
Hospital Pharmacy - June 2018 - 192
Hospital Pharmacy - June 2018 - 193
Hospital Pharmacy - June 2018 - Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - 195
Hospital Pharmacy - June 2018 - 196
Hospital Pharmacy - June 2018 - 197
Hospital Pharmacy - June 2018 - 198
Hospital Pharmacy - June 2018 - 199
Hospital Pharmacy - June 2018 - 200
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