Abstract
Background: Epidemiological evidence suggests that anti-inflammatory and immunomodulatory properties of statins may reduce the risk of infections and infection-related complications.
Objective: We aimed to assess the impact of prior statin use on coronavirus disease (COVID-19) severity and mortality.
Methods: In this observational multicenter study, consecutive patients hospitalized for COVID-19 were enrolled. In-hospital mortality and severity of COVID-19 assessed with National Early Warning Score (NEWS) were deemed primary and secondary outcomes, respectively. Propensity score (PS) matching was used to obtain balanced cohorts.
Results: Among 842 patients enrolled, 179 (21%) were treated with statins before admission. Statin patients showed more comorbidities and more severe COVID-19 (NEWS 4 [IQR 2-6] vs 3 [IQR 2-5], p < 0.001). Despite having similar rates of intensive care unit admission, noninvasive ventilation, and mechanical ventilation, statin users appeared to show higher mortality rates. After balancing pre-existing relevant clinical conditions that could affect COVID-19 prognosis with PS matching, statin therapy confirmed its association with a more severe disease (NEWS ≥5 61% vs. 48%, p = 0.025) but not with in-hospital mortality (26% vs. 28%, p = 0.185). At univariate logistic regression analysis, statin use was confirmed not to be associated with mortality (OR 0.901; 95% CI: 0.537 to 1.51; p = 0.692) and to be associated with a more severe disease (NEWS≥5 OR 1.7; 95% CI 1.067-2.71; p = 0.026).
Conclusions: Our results did not confirm the supposed favorable effects of statin therapy on COVID-19 outcomes. Conversely, they suggest that statin use should be considered as a proxy of underlying comorbidities, which indeed expose to increased risks of more severe COVID-19.
Keywords: Acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Coronavirus disease 2019 (COVID-19); In-hospital mortality; Statin therapy.
【저자키워드】 Coronavirus disease 2019 (COVID-19), in-hospital mortality, Acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Statin therapy., 【초록키워드】 COVID-19, coronavirus disease, Coronavirus disease 2019, therapy, Hospitalized, Mortality, intensive care, severe COVID-19, Anti-inflammatory, mechanical ventilation, severity, Comorbidities, Noninvasive ventilation, Comorbidity, outcomes, severity of COVID-19, Patient, statin, complications, multicenter, mortality rates, Admission, score, association, COVID-19 prognosis, Evidence, Propensity score, risk of infection, severe disease, Logistic regression analysis, 95% CI, increased risk, Secondary outcomes, cohorts, clinical condition, respiratory syndrome coronavirus, Affect, enrolled, was used, treated, reduce, consecutive patient, favorable effect, immunomodulatory property, 【제목키워드】 COVID-19, COVID-19 pandemic, Italy, Clinical outcome, Impact, tertiary referral hospital,