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July 18, 2007

Statin Use and Sepsis in Patients With Chronic Kidney Disease—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(3):284-285. doi:10.1001/jama.298.3.284-b

In Reply: Drs Chenaud and Merlani speculate on a possible mechanism to explain the association of statin use with reduced rate of hospitalization for sepsis in our analysis of the CHOICE study. They point out that apo A-I has been found to have potentially desirable effects in sepsis models and that statins may increase apo A-I levels.

There certainly have been interesting reports describing associations between cholesterol levels and sepsis outcomes,1,2 as well as multiple studies of apo A-I and high-density lipoprotein cholesterol in models of sepsis.3,4 We examined apo A-I levels that were available for a subset of our cohort (n = 850).5 While the levels were slightly higher in statin users than in control patients (135 vs 132 mg/dL, respectively [to convert to mmol/L, multiply by 0.0259]), the difference was not statistically significant (P = .31). Additionally, we did not find an association of apo A-I levels with incidence of hospitalization for sepsis (incidence rate ratio [IRR], 1.00 per 10-mg/dL increase; 95% confidence interval [CI], 0.96-1.04), and the addition of apo A-I level as an adjuster to our statin models did not attenuate the association (eg, original propensity score–adjusted model: IRR, 0.34; 95% CI, 0.19-0.60; same model with adjustment for apo A-I: IRR, 0.35; 95% CI, 0.20-0.62).

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