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Published on: February 24, 2023
Statin Use and Reduced Risk of Pneumonia in Patients with Melioidosis: A Lung-Specific Statin Association
Taylor D Coston1, Shelton W Wright2, Rungnapa Phunpang3,4
1Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine.
Abstract:
Rationale: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) use is associated with a lower risk of incident pneumonia and, less robustly, with nonpulmonary infections. Whether statin use is associated with a lower risk of pneumonia than other clinical presentations of infection with the same pathogen is unknown. Objectives: To assess whether preadmission statin use is associated with a lower risk of pneumonia than nonpneumonia presentations among patients hospitalized with Burkholderia pseudomallei infection (melioidosis). Methods: We performed a secondary analysis of a prospective multicenter cohort study of patients hospitalized with culture-confirmed B. pseudomallei infection (melioidosis). We used Poisson regression with robust standard errors to test for an association between statin use and pneumonia. We then performed several sensitivity analyses that addressed healthy user effect and indication bias. Results: Of 1,372 patients with melioidosis enrolled in the parent cohort, 1,121 were analyzed. Nine hundred eighty (87%) of 1,121 were statin nonusers, and 141 (13%) of 1,121 were statin users. Forty-six (33%) of 141 statin users presented with pneumonia compared with 432 (44%) of 980 statin nonusers. Statin use was associated with a lower risk of pneumonia in unadjusted analysis (relative risk, 0.74; 95% confidence interval, 0.58-0.95; P = 0.02) and, after adjustment for demographic variables, comorbidities, environmental exposures, and symptom duration (relative risk, 0.73; 95% confidence interval, 0.57-0.94; P = 0.02). The results of sensitivity analyses, including active comparator analysis and inverse probability of treatment weighting, were consistent with the primary analysis. Conclusions: In hospitalized patients with melioidosis, preadmission statin use was associated with a lower risk of pneumonia than other clinical presentations of melioidosis, suggesting a lung-specific protective effect of statins.
Insights
Statin use was linked to a reduced risk of pneumonia in patients hospitalized with melioidosis. This suggests statins may offer lung-specific protection against this infection.
Area of Science:
- Infectious Diseases
- Pharmacology
Background:
- 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) use is linked to reduced risks of pneumonia and other infections.
- It remains unknown if statins decrease pneumonia risk compared to other presentations of the same pathogen.
Purpose of the Study:
- To determine if preadmission statin use is associated with a lower risk of pneumonia compared to non-pneumonia presentations in patients hospitalized with Burkholderia pseudomallei (melioidosis).
Main Methods:
- A secondary analysis of a prospective multicenter cohort study involving patients with culture-confirmed B. pseudomallei infection.
- Poisson regression with robust standard errors was used to assess the association between statin use and pneumonia.
- Sensitivity analyses were conducted to address potential biases like the healthy user effect and indication bias.
Main Results:
- Of 1,121 analyzed patients, 13% were statin users. Statin users had a lower incidence of pneumonia (33%) compared to non-users (44%).
- Statin use was significantly associated with a reduced risk of pneumonia (adjusted RR, 0.73; 95% CI, 0.57-0.94; P = 0.02).
- Sensitivity analyses confirmed these findings, indicating robustness.
Conclusions:
- Preadmission statin use was associated with a lower risk of pneumonia in hospitalized melioidosis patients.
- Findings suggest a potential lung-specific protective effect of statins against B. pseudomallei infection.
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