dc.contributor.advisor | Mansur, Ashham PD Dr. | |
dc.contributor.author | Steinau, Maximilian | |
dc.date.accessioned | 2017-06-28T08:25:32Z | |
dc.date.available | 2017-07-06T22:50:08Z | |
dc.date.issued | 2017-06-28 | |
dc.identifier.uri | http://hdl.handle.net/11858/00-1735-0000-0023-3E8F-F | |
dc.identifier.uri | http://dx.doi.org/10.53846/goediss-6376 | |
dc.language.iso | deu | de |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.subject.ddc | 610 | de |
dc.title | Einfluss einer Statin-Therapie auf das Überleben von Patienten mit Sepsis-assoziiertem ARDS | de |
dc.type | doctoralThesis | de |
dc.title.translated | Impact of statin therapy on mortality in patients with sepsis-associated acute respiratory distress syndrome | de |
dc.contributor.referee | Hinz, José Prof. Dr. | |
dc.date.examination | 2017-06-29 | |
dc.description.abstracteng | The acute respiratory distress syndrome (ARDS)
was
first described in 1967. Even though therapy
has improved over the years,
its mortality remains high, especially if it is associated
to a sepsis.
The syndrome
consists of an overwhelming inflammation due to a previous direct or indirect
damage to the lung tissue. The inflammation leads to alveolar damage accompanied by an
infiltration of protein-rich pulmonary-edema fluid in the alveolar
space, leading to respiratory
failure. Despite the pulmonary failure,
a
persistance of the inflammation can also result in extra-
pulmonary organ failure, cellular damage
or death. Statins, a frequently prescribed medication
for treatment of hypercholesterolemia, may also attenuate inflammation due to their
immunosuppressive attributes and thus may have a positive impact on the outcome and the clinical
course of patients with ARDS. The aim of this study was to examine a potential benefit of a prior statin therapy on the survival of patients with sepsis-associated ARDS.
Therefore patients were screened
daily
in
three intensive care units (ICUs)
at
the University Medical Center of Goettingen
to
determine
if they would match the criteria for sepsis according to the American College of Chest
Physicians/Society of Critical Care Medicine (ACCP/SCCM).
If
positive,
the patients
were
furthermore evaluated according to the Berlin definition of ARDS (dividing ARDS into a mild,
moderate and severe form), to identify those with sepsis-associated
ARDS. All included patients
were checked for previous medication and followed
on,
up to a maximum of 28 days after the
onset of sepsis. If they had prior statin therapy, medication
was continued
on
the ICU. The organ
function was assessed at baseline using the Sequential Organ Failure Assessment-score (SOFA-score) and daily reassessed over the
next
28
days.
During their follow-up,
the primary outcome
variable of this examination was mortality. Out of 7673 screened patients, 404 who developed sepsis-
associated ARDS were enrolled in this study. Of these,
a total of 27% had prior statin therapy.
Exclusively in the patients with severe ARDS an improved
28-day survival could be examined (P
=
0.0193). After carrying a propensity score-matching, the improved 28-day survival among patients
with statin-therapy could be confirmed (P
= 0.0205). The performed Cox regression analysis to
exclude confounders supported the significance of statin therapy as a covariate for mortality
(hazard ratio, 5.46;
P
= 0.0156). In conclusion,
the study suggests that a prior statin therapy may
have a beneficial effect on patients with sepsis-associated ARDS. Despite the primary outcome
variable,
also
several secondary variables (such
as organ function)
also
showed improved results
in the statin therapy cohort. | de |
dc.contributor.coReferee | Koziolek, Michael Prof. Dr. | |
dc.contributor.thirdReferee | Zapf, Antonia PD Dr. | |
dc.subject.eng | ARDS | de |
dc.subject.eng | acute respiratory distress syndrome | |
dc.subject.eng | sepsis-associated acute respiratory distress syndrome | |
dc.subject.eng | statin therapy | |
dc.subject.eng | statins | |
dc.subject.eng | mortality | |
dc.subject.eng | survival analysis | |
dc.subject.eng | intensive care unit | |
dc.identifier.urn | urn:nbn:de:gbv:7-11858/00-1735-0000-0023-3E8F-F-5 | |
dc.affiliation.institute | Medizinische Fakultät | de |
dc.subject.gokfull | Medizin (PPN619874732) | de |
dc.description.embargoed | 2017-07-06 | |
dc.identifier.ppn | 891220046 | |