Relation of Statin Use Prior to Admission to Severity and Recovery Among COVID-19 Inpatients

Abstract

The impact of statins, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) severity and recovery is important given their high prevalence of use among individuals at risk for severe COVID-19. We studied the association between use of statin/angiotensin-converting enzyme inhibitors/ARB in the month before hospital admission, with risk of severe outcome, and with time to severe outcome or disease recovery, among patients hospitalized for COVID-19. We performed a retrospective single-center study of all patients hospitalized at University of California San Diego Health between February 10, 2020 and June 17, 2020 (n = 170 hospitalized for COVID-19, n = 5,281 COVID-negative controls). Logistic regression and competing risks analyses were used to investigate progression to severe disease (death or intensive care unit admission), and time to discharge without severe disease. Severe disease occurred in 53% of COVID-positive inpatients. Median time from hospitalization to severe disease was 2 days; median time to recovery was 7 days. Statin use prior to admission was associated with reduced risk of severe COVID-19 (adjusted OR 0.29, 95%CI 0.11 to 0.71, p < 0.01) and faster time to recovery among those without severe disease (adjusted HR for recovery 2.69, 95%CI 1.36 to 5.33, p < 0.01). The association between statin use and severe disease was smaller in the COVID-negative cohort (p for interaction = 0.07). There was potential evidence of faster time to recovery with ARB use (adjusted HR 1.92, 95%CI 0.81 to 4.56). In conclusion, statin use during the 30 days prior to admission for COVID-19 was associated with a lower risk of developing severe COVID-19, and a faster time to recovery among patients without severe disease.

Figure 1

Predictors of severe outcome (death or intensive care unit admission) among COVID-positive inpatients in a multivariable logistic regression model.

Figure 2

Cause-specific cumulative incidence curves for (A) time to severe COVID-19, and (B) time to recovery, stratified by statin use, with starting timepoint the earlier of first positive COVID-19 test or hospitalization for COVID-19. Severe COVID-19 was defined as death or admission to the Intensive Care Unit; recovery was defined as discharge from the hospital without ever experiencing a severe outcome. Includes all patients hospitalized for treatment of COVID-19 at UC San Diego Health from February 10, 2020 to June 17, 2020: 90 with severe outcome and 78 recovered. Two patients were censored at the time of analysis.