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Statins do not affect pneumonia patients’ LOS, mortality
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Statin therapy before and throughout hospitalization for community-acquired pneumonia did not appear to reduce hospital length of stay or in-hospital mortality, according to the results of a recent multicenter trial.
“Although best known for their benefits in cardiovascular disease, statins have anti-inflammatory and immunomodulatory effects, and several large observational studies suggest that statins may improve clinical outcomes in infectious processes,” Fiona Havers, MD, MHS, medical officer in the CDC’s Influenza Division, and colleagues wrote. “No definitive [randomized controlled trials (RCTs)] have examined the effect of statins on [community-acquired pneumonia (CAP)] outcomes, including in hospitalized patients.”
To fill this gap, Havers and colleagues enrolled adult CAP patients receiving care at five U.S. hospitals between January 2010 and June 2012. They compared length of stay (LOS) and in-hospital mortality between patients using statins before admission and during care (n = 483) and those who never used statins before or during hospitalization (n = 1,533). In addition to multivariable analysis, the researchers also conducted two separate analyses incorporating patient propensity scores and pneumonia severity.
The researchers observed a significant age disparity between groups, with statin users aged a median 16 years older than nonusers (P <.001). Statin users also were more likely to be male or obese, and more often had health insurance or additional comorbidities.
While statin users experienced longer crude median LOS than nonusers, adjusted multivariable regression found no difference between the groups (adjusted HR = 0.99; 95% CI, 0.88-1.12). LOS remained similar when limiting the analysis to ICU patients (aHR = 1.16; 95% CI, 0.88-1.53), or when analyzing LOS by patient propensity scores and illness severity. There were no significant mortality differences between the groups in the general multivariate analysis (aOR = 0.8; 95% CI, 0.35-1.82) or other subanalyses.
Havers and colleagues’ findings contrast observational data suggesting a benefit from statin treatment in CAP patients. Because nonefficacy was previously reported only among studies detailing clinical characteristics and propensity scores, studies showing improved outcomes may have been susceptible to various confounders such as the increased age and comorbidity rate of statin users, the researchers hypothesized.
“After adjusting for potential confounding, we found no significant difference in LOS and in-hospital mortality between statin users and nonusers among adults hospitalized with CAP,” they wrote. “Our study supports data from both RCTs and prospective observational studies that control for healthy user effects, which have not found associations between statin use and clinical outcomes in patients hospitalized with various infections.” – by Dave Muoio
Disclosure: Havers reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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