Association between statins given in hospital and mortality in pneumonia patients

Abstract

Background: Statins are prescribed to lower cholesterol, but also have anti-inflammatory properties. Some observational studies suggest that statins may reduce mortality from sepsis.

Methods: Using a highly detailed administrative database, we conducted an observational cohort study of all patients aged ≥18 years who received a discharge diagnosis of pneumonia from 2003-2005 at 376 hospitals. Patients with contraindications to statins, and those unable to take oral medications or discharged within 2 days were excluded. We used multivariable logistic regression and propensity matching to compare mortality among patients who did and did not receive statins on hospital day 1 or 2.

Results: Of the 121,254 patients who met the inclusion criteria, median age was 74; 56% were female and 70% were white; 19% received a statin on day 1 or 2. Compared to patients who did not receive statins, statin-treated patients were less likely to be admitted to intensive care (15.7% vs 18.1%, p < 0.001), require mechanical ventilation (6.9% vs. 9.3%, p < 0.001), or die in hospital (3.9% vs 5.7%, p < 0.001). After multivariable adjustment, including the propensity for statin treatment and severity at presentation, mortality was lower in statin-treated patients [OR for propensity-adjusted 0.86 (95% CI 0.79 to 0.93) OR for propensity-matched 0.90, (0.82 to 0.99)]. For patients admitted to intensive care the adjusted odds ratio for mortality with statins was 0.93 (95% CI 0.81 to 1.06), whereas outside intensive care it was 0.79 (95% CI 0.71 to 0.87).

Conclusions: Inpatient treatment with statins is associated with a modest reduction in pneumonia mortality outside of intensive care.

Figure 1

Relative odds of mortality associated with statin use in the first 2 hospital days. *Adjusted for: age, gender, smoking, congestive heart failure, lymphoma, metastatic cancer, other neurologic disorders, obesity, pulmonary circulation disease, renal failure, solid tumor without metasasis, valvular disease, weight loss, depression, hypertension, psychoses, primary diagnosis, pneumonia type, initial antibiotic(s) received, early treatment (day 1 or 2) with angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, Foley catheter, restraints, nutritional supplements, total parenteral nutrition, gastrostomy or jejunostomy tube, thiamine, calcium or mechanical ventilation. †Variables in propensity model: All variables above, plus admission from skilled nursing facility, insurance type, marital status, race/ethnicity, hospital geographic region, number of beds, teaching hospital, and setting (urban/rural), attending specialty, acquired immune sufficiency syndrome, alcohol abuse, deficiency anemia, collagen vascular disease, chronic blood loss anemia, chronic pulmonary disease, diabetes, drug abuse, hypothyroidism, ischemic heart disease, paralysis, peripheral vascular disease, peptic ulcer disease and bleeding, aspirin, bisphosphonates, clopidogrel, folic acid, glucosamine, multivitamin, vitamin B2, B5, B6, C, D or E, dementia medications, collagenase, prealbumin, psychotropic drugs, silvadene, antidepressants, beta blockers, calcium channel blocker, diuretics, ezetimibe, fibrates, amiodorone, inhaled bronchodialators, inhaled corticosteroids, insulin, immunosuppressants, niacin, nitroglycerin, non-steroidal anti-inflammatory drugs, proton pump inhibitors, resins, steroids, thyroid replacement therapy, and warfarin. ‡All stratified analyses adjusted for propensity score and co-variates.