Key result
Statin use before or during mechanical ventilation was associated with a 21% reduction in the hazard of 28-day mortality compared to non-use in a propensity-matched cohort (HR 0.79).
Why the study?
Mechanical ventilation can cause injury and inflammatory lung disorders in critically ill patients, leaving uncertainty about whether statin treatment offers a protective clinical effect.
Does statin treatment improve survival in mechanically ventilated patients?
Cohort (n=21,451)
No
Does statin treatment improve survival in mechanically ventilated patients?
Statin use is associated with improved short-term survival and more ventilator-free days in mechanically ventilated patients, particularly those without severe inflammatory conditions like pneumonia or sepsis.
Answers are grounded in this paper and cite their sources.
Statin use may improve short-term survival in ventilated patients; hypothesis-generating and requires RCTs before any practice change.
Background: The patients on mechanical ventilation were always critically ill and ventilation may cause injury and inflammatory disorders in the lungs of such patients. We sought to determine whether statin treatment has a protective effect on the outcome of the ventilated patients. Methods: A retrospective observational study of mechanically ventilated patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. To ensure the robustness of the findings, we utilized the gradient boosted model, propensity score analysis, doubly robust estimation and an inverse probability‐weighting model in the statistical procedure. The propensity score of statin use was calculated by age, sex, severity scores and 32 other variables. Results: Compared with nonusers, the use of statins was associated with improved 28-day survival in the unmatched cohort (HR 0.85 95% CI 0.80~0.90) and matched cohort (HR 0.79 95% CI 0.73~0.85). Statin use was also associated with improved 60-day (HR 0.81 95%CI 0.75~0.85), 90-day (HR 0.81 95%CI 0.76~0.86) and in-hospital (HR 0.81 95%CI 0.76~0.86) survival in the matched cohort. Statins use was associated with longer ventilator free days (VFD28, 14.93±13.11 vs 12.06±13.26) and longer ICU free days (13.41±12.14 vs 10.86 ±12.19) in the matched cohort. Different types of statins were associated with improved 28-day survival. The subgroup analyses results showed improved 28-day survival in most subgroups, but this improvement was not observed in patients with pneumonia, septicemia or acute respiratory failure. Conclusions: In a population of mechanically ventilated patients, the use of statins may be associated with reduced mortality. This protective effect was observed only in mild-to-moderate patients instead of critical inflammatory ones.Trial registration: http://www.chictr.org.cn/index.aspx; Registration number: ChiCTR2000029594
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Chen et al. (2021) conducted a cohort in Mechanically ventilated patients (n=21,451). Statin use vs. Non-statin use was evaluated on 28-day all-cause mortality (HR 0.79, 95% CI 0.73-0.85, p=<0.001). Statin use before or during mechanical ventilation was associated with a 21% reduction in the hazard of 28-day mortality compared to non-use in a propensity-matched cohort (HR 0.79).
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