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Statin and Its Association With Delirium in the Medical ICU
Jeffrey F Mather1, John P Corradi, Christine Waszynski
11Department of Research Administration, Hartford Hospital, Hartford, CT. 2Department of Geriatrics, Hartford Hospital, Hartford, CT. 3Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI. 4Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT.
Insights
Statin use significantly reduced the risk of delirium in medical intensive care unit patients. Specific statins like atorvastatin, pravastatin, and simvastatin showed protective effects against delirium development.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Neurology
Background:
- Delirium is a common complication in hospitalized patients, particularly in the medical intensive care unit (MICU).
- Statins are widely used lipid-lowering medications with potential anti-inflammatory and neuroprotective properties.
Purpose of the Study:
- To investigate the association between statin use and the incidence of delirium in patients admitted to a medical ICU.
- To determine if specific types of statins confer a greater protective effect against delirium.
Main Methods:
- A retrospective propensity-matched cohort analysis was conducted.
- 1,475 patients from a medical ICU were included, matched 1:1 for statin users and non-statin users.
- Delirium was assessed using the Confusion Assessment Method.
Main Results:
- Statin use was associated with a significant reduction in the risk of delirium (OR, 0.47; 95% CI, 0.38-0.56).
- Atorvastatin, pravastatin, and simvastatin were all significantly associated with a lower frequency of delirium.
- The prevalence of delirium was similar in unmatched and matched cohorts (22.3% vs. 22.8%).
Conclusions:
- Statin therapy is independently associated with a reduced risk of delirium in hospitalized ICU patients.
- Specific statins, including atorvastatin, pravastatin, and simvastatin, demonstrate significant protective effects.
- Further randomized trials are recommended to confirm the protective role of statins against delirium.
Objectives:
To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU.
Design:
Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015.
Setting:
Hartford Hospital, Hartford, CT.
Patients:
An initial population of patients with an admission to a medical ICU totaling 10,216 visits were screened for delirium by means of the Confusion Assessment Method. After exclusions, a population of 6,664 was used to match statin users and nonstatin users. The propensity-matched cohort resulted in a sample of 1,475 patients receiving statin matched 1:1 with control patients not using statin.
Interventions:
None.
Measurements And Main Results:
Delirium defined as a positive Confusion Assessment Method assessment was the primary end point. The prevalence of delirium was 22.3% in the unmatched cohort and 22.8% in the propensity-matched cohort. Statin use was associated with a significant decrease in the risk of delirium (odds ratio, 0.47; 95% CI, 0.38-0.56). Considering the type of statin used, atorvastatin (0.51; 0.41-0.64), pravastatin (0.40; 0.28-0.58), and simvastatin (0.33; 0.21-0.52) were all significantly associated with a reduced frequency of delirium.
Conclusions:
The use of statins was independently associated with a reduction in the risk of delirium in hospitalized patients. When considering types of statins used, this reduction was significant in patients using atorvastatin, pravastatin, and simvastatin. Randomized trials of various statin types in hospitalized patients prone to delirium should validate their use in protection from delirium.
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