October 2017 Journal Club

For October we looked at an interesting paper;

(https://www.ncbi.nlm.nih.gov/pubmed/28622167)

Which suggests the possibility of alternative treatment strategies for Delirium, have a look and feel free to add to the discussion thread below…..

“Hi All

Hope you all enjoyed the paper and apologies to anyone who found it a bit “dry”!

Basically it’s a retrospective study looking at whether statin use prior to ICU admission affected the incidence of delirium (as defined by the CAM or CAM-ICU score).

It showed that on the whole a statin seems to reduce your risk of developing delirium.

Clearly this interesting finding has to be taken with a degree of healthy scepticism as the study is a retrospective data “trawl” rather than a prospective study and therefore, despite their attempts to adjust for confounding factors, may reflect association rather than causation.

However it is an interesting study that raises a number of avenues worth pursuing with further research. In particular I think it merits attention because it highlights that delirium is probably the brain’s response to an inflammatory insult (such as sepsis, trauma, major complex surgery etc.) occurring elsewhere in the body and that potentially modifying the hosts response to that inflammatory process could have a neuroprotective effect.

On the whole statins probably exert their beneficial effects via their anti-inflammatory properties rather than their ability to lower LDL cholesterol and maybe patients who have been on them, over time, under go “immunomodulation” to a less pro-inflammatory state. In theory that means that when that external pro-inflammatory “hit” comes along they have a subtle but significant advantage as they are then less likely to be pushed into the full blown cytokine storm that leads to all sorts of badness…..

I’d be interested to see what a prospective trial looking into this shows, but I suspect that starting it once a patient has already had the inflammatory hit would not be as helpful as by that point the horse has already bolted.

However in theory pre-op statins in the high risk surgical cohort might be a potential strategy to reduce the rates of delirium in that group and they would certainly be a easier group to identify in advance. Does anyone know of any work out there into this?

Hope that makes sense, let me know what you think!”

 

“Thanks Rob for the summary.

There has been a lot of ‘recent’ interest and research focussed on the benefits of statins in ICU (ARDS, VAP, Delirium….) and whilst theoretically they sound like the perfect solution in terms of modulating the inflammatory processes associated with critical illness, they don’t seem to produce the results in trials that are hoped for. That said this seems to cry out for one of those large scale multicentre, international collaborative trials…..which are larger, slightly better controlled and possibly less heterogeneous.

I have to agree that it seems slightly counter-intuitive to only start a statin once the inflammatory process of critical illness is already in full swing…..and I’m sure the drug companies would also love us all to be on a statin as part of the 5-a-day!

I’m just not sure we are going to find a magic bullet for this one…”

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s