Intensive Care Medicine

, Volume 43, Issue 5, pp 663–671 | Cite as

Statin therapy for acute respiratory distress syndrome: an individual patient data meta-analysis of randomised clinical trials

  • Myura Nagendran
  • Daniel F. McAuley
  • Peter S. Kruger
  • Laurent Papazian
  • Jonathon D. Truwit
  • John G. Laffey
  • B. Taylor Thompson
  • Mike Clarke
  • Anthony C. Gordon
Systematic Review

Abstract

Purpose

We performed an individual patient data meta-analysis to assess the possible benefits and harms of statin therapy in adults with acute respiratory distress syndrome (ARDS) and to investigate effects in specific ARDS subgroups.

Methods

We identified randomised clinical trials up to 31 October 2016 that had investigated statin therapy versus placebo in patients with ARDS. Individual patient data from each trial were compiled. Conventional two-stage meta-analyses were performed for primary and secondary outcomes, and one-stage regression models with single treatment–covariate interactions for subgroup analyses. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

Results

Six trials with a total of 1755 patients were included. For the primary outcomes, there was no significant effect of statin therapy on 28-day mortality [relative risk (RR) 1.03, 95% CI 0.86–1.23], ventilator-free days (mean difference 0.34 days, 95% CI −0.68 to 1.36) or serious adverse events (RR 1.14, 95% CI 0.84–1.53). There was a significantly increased incidence of raised serum creatine kinase or transaminase levels with statin therapy (106/879; 12.1%) versus control (78/876; 8.9%) (RR 1.40, 95% CI 1.07–1.83, p = 0.015). There were no significant treatment–covariate interactions in the predefined subgroups investigated.

Conclusions

We found no clinical benefit from initiation of statin therapy in adult patients with ARDS, either overall or in predefined subgroups. While there was an increased incidence of raised serum creatine kinase and transaminase levels, there was no difference in serious adverse events among groups. Therefore, we do not recommend initiation of statin therapy for the treatment of ARDS.

Keywords

Statin ARDS ALI Meta-analysis 

Supplementary material

134_2016_4649_MOESM1_ESM.docx (777 kb)
Supplementary material 1 (DOCX 776 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Myura Nagendran
    • 1
  • Daniel F. McAuley
    • 2
  • Peter S. Kruger
    • 3
    • 8
  • Laurent Papazian
    • 4
  • Jonathon D. Truwit
    • 5
  • John G. Laffey
    • 6
  • B. Taylor Thompson
    • 7
  • Mike Clarke
    • 2
  • Anthony C. Gordon
    • 1
  1. 1.Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and CancerImperial College London and Charing Cross HospitalLondonUK
  2. 2.School of Medicine, Dentistry and Biomedical SciencesQueen’s University of BelfastBelfastUK
  3. 3.Princess Alexandra HospitalMetro South HealthWoolloongabbaAustralia
  4. 4.Medical Intensive Care UnitNorth Hospital, Aix-Marseille UniversityMarseilleFrance
  5. 5.Pulmonary and Critical Care MedicineFroedtert and Medical College of WisconsinMilwaukeeUSA
  6. 6.Departments of Anesthesia and Critical Care MedicineSt Michael’s Hospital, University of TorontoTorontoCanada
  7. 7.Division of Pulmonary and Critical Care MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  8. 8.School of MedicineUniversity of QueenslandBrisbaneAustralia

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