Saturday, March 31, 2012

Association of Statin Use with Risk and Outcome of Acute Kidney Injury in Community-Acquired Pneumonia.




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Association of Statin Use with Risk and Outcome of Acute Kidney Injury in Community-Acquired Pneumonia.



Clin J Am Soc Nephrol. 2012 Mar 29;
Murugan R, Weissfeld L, Yende S, Singbartl K, Angus DC, Kellum JA,

Background and objectivesSepsis is a leading cause of AKI. Animal studies suggest that the pleiotropic effect of statins attenuates the risk for AKI and decreases mortality. This study examined whether statin use was associated with a lower risk for pneumonia-induced AKI and 1-year and cause-specific mortality in patients with AKI.Design, setting, participants, & measurementsMulticenter, prospective cohort study of 1836 patients hospitalized with community-acquired pneumonia.ResultsBaseline characteristics differed among statin users and nonusers. Of the 413 patients (22.5%) who received a statin before hospitalization, statin treatment, when adjusted for differences in age, severity of pneumonia, admission from nursing home, health insurance, and propensity for statin use, did not reduce the risk for AKI (odds ratio [OR], 1.32 [95% confidence interval (CI), 1.02-1.69]; P=0.05). Of patients with AKI (n=631), statin use was associated with a lower risk for death at 1 year (27.8% versus 38.8%; P=0.01), which was not significant when adjusted for differences in age, severity of pneumonia and AKI, use of mechanical ventilation, and propensity score (OR, 0.72 [95% CI, 0.50-1.06]; P=0.09). Among patients with AKI, cardiovascular disease accounted for one third of all deaths.ConclusionsIn a large cohort of patients hospitalized with pneumonia, statins did not reduce the risk for AKI. Among patients with AKI, statin use was not associated with lower risk for death at 1 year. The higher risk for AKI observed among statin users may be due to indication bias.








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Healthcare Jujitsu: A Path to Medicare for All



Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.






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