Association of Statin Use with Risk and Outcome of Acute Kidney Injury in Community-Acquired Pneumonia

BACKGROUND AND OBJECTIVES: Sepsis is a leading cause of AKI. Animal studies suggest that the pleiotropic effect of statins attenuates the risk for AKI and decreases mortality. This study examined whether statin use was associated with a lower risk for pneumonia-induced AKI and 1-year and cause-specific mortality in patients with AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multicenter, prospective cohort study of 1836 patients hospitalized with community-acquired pneumonia. RESULTS: Baseline characteristics differed among statin users and nonusers. Of the 413 patients (22.5%) who received a statin before hospitalization, statin treatment, when adjusted for differences in age, severity of pneumonia, admission from nursing home, health insurance, and propensity for statin use, did not reduce the risk for AKI (odds ratio [OR], 1.32 [95% confidence interval (CI), 1.02-1.69]; P=0.05). Of patients with AKI (n=631), statin use was associated with a lower risk for death at 1 year (27.8% versus 38.8%; P=0.01), which was not significant when adjusted for differences in age, severity of pneumonia and AKI, use of mechanical ventilation, and propensity score (OR, 0.72 [95% CI, 0.50-1.06]; P=0.09). Among patients with AKI, cardiovascular disease accounted for one third of all deaths. CONCLUSIONS: In a large cohort of patients hospitalized with pneumonia, statins did not reduce the risk for AKI. Among patients with AKI, statin use was not associated with lower risk for death at 1 year. The higher risk for AKI observed among statin users may be due to indication bias.