Association Between Antecedent Statin Use and Decreased Mortality in Hospitalized Patients with COVID-19

Abstract

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections and ARDS, but their benefit has not been assessed in COVID-19. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1 ^st through May 12 ^th , 2020 with study period ending on June 11 ^th , 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, demographic, baseline, and outpatient medication information were well balanced. Statin use was significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.48, 95% CI 0.36 â€" 0.64, p<0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 was associated with lower inpatient mortality. Randomized clinical trials evaluating the utility of statin therapy in patients with COVID-19 are needed.

Figure 1

Forest Plot for In-Hospital Mortality Within 30 Days. Forest plot demonstrating the odds ratio (OR) and 95% confidence interval (CI) for in-hospital mortality within 30 days with antecedent statin use (vs. no antecedent statin use) after multivariable logistic regression in the overall cohort. A number of other sociodemographic and baseline medication variables are also presented in this forest plot.

Figure 2

Forest Plot for In-hospital Mortality or Invasive Mechanical Ventilation Within 30 days. Forest plot demonstrating the odds ratio (OR) and 95% confidence interval (CI) for the composite endpoint of in-hospital mortality or invasive mechanical ventilation requirement within 30 days with antecedent statin use (vs. no antecedent statin use) after multivariable logistic regression in the overall cohort. A number of other sociodemographic and baseline medication variables are also presented in this forest plot.