In the United States, rates of infectious disease-related hospitalizations and mortality have remained stable or increased significantly for those >65 years of age, and the majority of these deaths are related to community-acquired pneumonia (CAP) and sepsis. Cytokines play a central role in the host defense mechanisms for patients with bacterial infectious diseases but may lead to septic shock or acute respiratory distress syndrome, and several common medications including statins, ACE inhibitors, and angiotensin receptor blockers (ARBs) have been demonstrated to reduce systemic inflammation due to cytokines. Several small studies have demonstrated that patients on statins or ACE inhibitors hospitalized with infectious disorders have improved clinical outcomes. However, further research is needed to clarify whether these medications may be beneficial in the care of patients with CAP and sepsis.
The aims of this study are: 1) Determine the association between the outpatient use of medications of interest and clinical outcomes, including 30-day mortality, length of stay (LOS), and rates of mechanical ventilation for patients hospitalized with sepsis and CAP. 2) Determine the association between the inpatient continuation of medications of interest properties and clinical outcomes for patients hospitalized with CAP and sepsis. 3) To examine the impact of medication dosage of the most commonly used ACE inhibitor and statin upon 30-day mortality for patients hospitalized with CAP and sepsis. The proposed study is a retrospective, cohort study secondary data analysis of data gathered from several VA sources and merged to examine the impact of ACE inhibitors, ARBS, and statins upon important clinical outcomes for patients hospitalized with CAP and sepsis. The cohort will consist of all patients hospitalized in Department of Veterans Affairs (VA) hospitals with either CAP or sepsis in fiscal years 2002-2005 who received at least 1 year of primary care prior to admission. Data to obtained includes demographics, comorbid conditions, medications used as an outpatient and inpatient, and inpatient laboratory data, using the clinical databases of the VA health care system. Separate analyses will be performed for patients with sepsis and CAP. The primary outcome will be 30-day mortality, and secondary outcomes will be length of stay and rates of mechanical ventilation. The primary analyses will examine the impact of the medications of interest upon the clinical outcomes using generalized linear mixed-effect models. Relevance: Findings from this study will be used to determine a) whether randomized controlled trials testing the impact of these drugs on infectious disease outcomes should be conducted, and b) to better understand if these medications should be routinely recommended for populations at high-risk for pneumonia and/or sepsis.
|Frei, Christopher R; Rehani, Sylvie; Lee, Grace C et al. (2017) Application of a Risk Score to Identify Older Adults with Community-Onset Pneumonia Most Likely to Benefit From Empiric Pseudomonas Therapy. Pharmacotherapy 37:195-203|
|Attridge, Russell T; Frei, Christopher R; Pugh, Mary Jo V et al. (2016) Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. J Crit Care 36:265-271|
|Metersky, Mark L; Frei, Christopher R; Mortensen, Eric M (2016) Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia. Respirology 21:157-63|
|Teshome, Besu F; Lee, Grace C; Reveles, Kelly R et al. (2015) Application of a methicillin-resistant Staphylococcus aureus risk score for community-onset pneumonia patients and outcomes with initial treatment. BMC Infect Dis 15:380|
|Sibila, Oriol; Laserna, Elena; Maselli, Diego Jose et al. (2015) Risk factors and antibiotic therapy in P.?aeruginosa community-acquired pneumonia. Respirology 20:660-6|
|Mortensen, Eric M; Halm, Ethan A; Pugh, Mary Jo et al. (2014) Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA 311:2199-208|
|Tang, Victoria L; Halm, Ethan A; Fine, Michael J et al. (2014) Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system. J Hosp Med 9:379-83|
|Johnson, Christopher S; Frei, Christopher R; Metersky, Mark L et al. (2014) Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study. BMC Pulm Med 14:7|
|Lemay, Allyson C; Anzueto, Antonio; Restrepo, Marcos I et al. (2014) Predictors of long-term mortality after severe sepsis in the elderly. Am J Med Sci 347:282-8|
|Wu, Albert; Good, Chester; Downs, John R et al. (2014) The association of cardioprotective medications with pneumonia-related outcomes. PLoS One 9:e85797|
Showing the most recent 10 out of 28 publications