Association of Statin Use with 28-Day Mortality in the MIMIC-IV Database: A Cohort Study

Background Statins, acknowledged for their cardiovascular risk reduction, exhibit pleiotropic effects, including anti-inflammatory, antithrombotic, and endothelial stabilizing actions. While intensive care unit (ICU) patients face heightened risks of cardiovascular disease, infections, and thrombotic complications, the impact of statin therapy on ICU mortality remains debated. Aim This retrospective cohort study, utilizing the Medical Information Mart for Intensive Care IV (MMIC-IV) database, aims to scrutinize the association between statin therapy and all-cause mortality in critically ill patients. Additionally, it endeavors to compare the impact of different statin types on mortality. Method Eligible ICU-admitted patients aged 18–90 were categorized based on statin usage during their ICU stay. The primary outcome was 28-day mortality, analyzed through multivariable Cox regression, providing adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results Among 50,624 enrolled patients, 30.9% used statins. Statin treatment in ICU patients was correlated with reduced 28-day all-cause mortality in multivariate Cox analysis (Statins [HR] = 0.66, [95% CI, 0.61–0.70]; atorvastatin [HR] = 0.71, [95% CI, 0.66–0.78]; rosuvastatin [HR] = 0.57, [95% CI, 0.45–0.72]; simvastatin [HR] = 0.54, [95% CI, 0.48–0.62]; other statins [HR] = 0.68, [95% CI, 0.56–0.83]). Propensity score matching confirmed these findings (statins [HR] = 0.69, [95% CI, 0.63–0.75]). Conclusion Statin use may correlate with a decreased risk of 28-day mortality in ICU patients, with simvastatin showing a more pronounced effect. The robustness of these findings remain unaffected by subgroup analyses, sensitivity analyses, and propensity score matching, indicating potential clinical significance.