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.

Impact of prior statin use on clinical outcomes in COVID-19 patients : data from tertiary referral hospitals during COVID-19 pandemic in Italy / G. Mitacchione, M. Schiavone, A. Curnis, M. Arca, S. Antinori, A. Gasperetti, G. Mascioli, P. Severino, F. Sabato, M.M. Caracciolo, G. Arabia, L. D'Erasmo, M. Viecca, M. Mancone, M. Galli, G.B. Forleo. - In: JOURNAL OF CLINICAL LIPIDOLOGY. - ISSN 1933-2874. - 15:1(2021 Jan), pp. 68-78. [10.1016/j.jacl.2020.12.008]

Impact of prior statin use on clinical outcomes in COVID-19 patients : data from tertiary referral hospitals during COVID-19 pandemic in Italy

M. Schiavone;S. Antinori;A. Gasperetti;F. Sabato;M. Galli;
2021-01

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.
Acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Coronavirus disease 2019 (COVID-19); In-hospital mortality; Statin therapy; Adult; Aged; COVID-19; Disease-Free Survival; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Survival Rate; Tertiary Care Centers; Hospital Mortality; SARS-CoV-2
Settore MED/17 - Malattie Infettive
Settore MED/09 - Medicina Interna
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
dic-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/867437
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