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. 2025 Jul 30:12:1594164.
doi: 10.3389/fmed.2025.1594164. eCollection 2025.

Effects of non-HDL-C and statin therapy on mortality in ARDS: a retrospective cohort study

Haiming Hu #  1   2   3 , Jin Wei #  4 , Lijuan Zhao  3   5 , Yixing Zhu  1   2   3 , Geer Zhou  1   2   3 , Anqi Zhao  1   2   3 , De Chang  1   2
Affiliations

Effects of non-HDL-C and statin therapy on mortality in ARDS: a retrospective cohort study

Haiming Hu et al. Front Med (Lausanne). .

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a critical and potentially fatal condition marked by inflammation and coagulation disorders. Statins, a class of cholesterol-lowering medications, have been explored for potential anti-inflammatory properties, yet their exact role in ARDS remains unclear.

Methods: Patients diagnosed with ARDS were sourced from the MIMIC-IV database (version 3.0). To balance baseline characteristics, propensity score matching (PSM) was applied. Short-term mortality was evaluated using Kaplan-Meier survival analysis. Factors associated with short-term mortality were determined using both univariate and multivariate Cox regression analyses. The potential impact of unmeasured confounding was assessed using the E-value. Additionally, subgroup analyses were performed to investigate heterogeneity and evaluate the robustness of the findings.

Results: The study included 10,368 ARDS patients, of whom 5,184 received statin therapy and 5,184 did not. Kaplan-Meier analysis revealed significantly lower short-term mortality in the statin-treated group. Both univariate (HR, 0.48; 95% CI, 0.41-0.58; p < 0.001) and multivariate (HR, 0.49; 95% CI, 0.41-0.58; p < 0.001) Cox regression analyses revealed that statin therapy significantly decreased short-term mortality. Subsequent subgroup analyses further indicated that the beneficial effect of statins was more evident in patients with elevated non-HDL-C levels.

Conclusion: Statin therapy appears to confer significant clinical benefits in ARDS patients, particularly in those with high non-HDL-C levels. These findings indicate that non-HDL-C might be a useful marker for identifying ARDS patients who may benefit most from statin therapy.

Keywords: ARDS; MIMIC-IV database; clinical prognosis; non-HDL-C; statin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart illustrating the patient selection process for the study analysis.
Figure 2
Figure 2
K-M survival curves for ARDS patient mortality. (a) 7-day mortality; (b) 30-day mortality; (c) 90-day mortality.
Figure 3
Figure 3
Subgroup analysis on the impact of clinical intervention on 7-day mortality in ARDS patients. (a) statin therapy and 7-day mortality (no cholesterol-related data); (b) glucocorticoid therapy and 7-day mortality (added cholesterol-related data); (c) statin therapy and 7-day mortality (added cholesterol-related data).
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