Association between pre-ICU statin use and ARDS mortality in the MIMIC-IV database: a cohort study

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a severe condition associated with high morbidity, mortality, and healthcare costs. Despite extensive research, treatment options for ARDS are suboptimal.

Methods: This study encompassed patients diagnosed with ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Pre-intensive care unit (ICU) statin use was assessed as the exposure variable. Kaplan-Meier survival analysis was conducted to evaluate mortality at 30 and 90 days. Adjusted multivariable Cox models were utilized to estimate hazard ratios. Subgroup analyses and propensity score-matching (PSM) were undertaken for further validation.

Results: Our study comprised 10,042 participants diagnosed with ARDS, with an average age of 61.8 ± 15.3 years. Kaplan-Meier survival analysis demonstrated a significantly lower prevalence of mortality at 30 and 90 days in individuals who used statins before ICU admission. Adjusted multivariable Cox models consistently showed a significant decrease in mortality prevalence associated with pre-ICU statin use. After accounting for confounding factors, patients who used statins before ICU admission experienced a 39% reduction in 30-day mortality and 38% reduction in 90-day mortality. We found a significant decrease in ICU stay (0.84 days) for those who used statins before ICU admission. These results were supported by subgroup analyses and PSM.

Conclusion: This large cohort study provides evidence supporting the association between pre-ICU statin use, reduced risk of death, and shorter ICU stay in patients with ARDS, thereby suggesting the potential benefits of statin use in critically ill patients.

Keywords: ICU; Medical Information Mart for Intensive Care-IV; cohort study; mortality; statins.

Figure 1

Flowchart of this study.

Figure 2

Kaplan–Meier survival curves for ICU patients at day 90 and categorized on pre-ICU statin use.

Figure 3

Association between pre-ICU statin use and 30-day mortality according to baseline characteristics. Each stratification adjusted for all the factors (age, sex, BMI, ethnicity, insurance, temperature, heart rate, MAP, respiration rate, SPO2, glucose, PH, PO2, PCO2, PO2/FiO2, lactate, sodium, potassium, WBC, HB, PLT, Scr, Bun, ventilation, vasoactive drugs, CRRT, SAPS II, SOFA, charlson comorbidity index, myocardial infarct, congestive heart failure, cerebrovascular disease, chronic pulmonary disease, diabetes without complication, diabetes with complication, renal disease, malignant cancer, severe liver disease, sepsis) except the stratification factor itself. BMI, body mass index; ARDS, Acute Respiratory Distress Syndrome; SOFA, Sequential Organ Failure Assessment.