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Statin Therapy, Inflammation, and Outcomes in Patients Hospitalized for COVID-19: A Prospective Multicenter Cohort
Anis Ismail1, Husam R Shadid2, Yiyuan Huang3
1Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston.
Insights
Prior statin use in hospitalized COVID-19 patients was linked to better outcomes and reduced inflammation. This includes lower odds of death, mechanical ventilation, and renal replacement therapy, with suPAR levels playing a key role.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Statins, known for lipid-lowering and anti-inflammatory properties, have conflicting data regarding their benefit in COVID-19.
- Understanding statins' impact on COVID-19-related inflammation is crucial.
Purpose of the Study:
- To investigate the association between prior statin use and clinical outcomes in hospitalized COVID-19 patients.
- To explore the relationship between statin use, inflammation biomarkers, and COVID-19 severity.
Main Methods:
- Prospective multicenter cohort study (International Study of Inflammation in COVID-19) from February 2020 to October 2022.
- Systematic assessment of inflammation biomarkers and logistic regression with inverse probability-of-treatment weighting (IPTW).
- Examined the composite outcome of in-hospital death, mechanical ventilation, and renal replacement therapy.
Main Results:
- 4464 patients included; 27.5% were on prior statin therapy.
- Statin use was associated with lower soluble urokinase plasminogen activator receptor (suPAR) levels.
- Statin use correlated with reduced odds of the composite outcome (aOR 0.63) and findings were consistent with IPTW (aOR 0.92).
Conclusions:
- Prior statin use is associated with improved outcomes in hospitalized COVID-19 patients.
- Lower inflammation, indicated by suPAR levels, is linked to statin use in this population.
- suPAR partially mediates the beneficial effect of statins on COVID-19 outcomes.
Background:
Statins are lipid-lowering agents with anti-inflammatory effects. Data surrounding the benefits of statins in patients with coronavirus disease 2019 (COVID-19) are conflicting. We sought to better understand the impact of statins in the context of COVID-19-related inflammation.
Methods:
We leveraged the International Study of Inflammation in COVID-19, a prospective multicenter cohort of patients hospitalized for COVID-19 between February 2020 and October 2022. Participants underwent systematic assessment of biomarkers of inflammation. We used logistic regression modeling and inverse probability-of-treatment weighting (IPTW) to examine the association between prior statin use and the composite outcome of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy.
Results:
A total of 4464 patients were included in the study, of whom 1364 (27.5%) were taking a statin prior to admission. There were 1061 primary outcome events, including 540 deaths, 854 mechanical ventilation and 313 renal replacement therapy. Amongst biomarkers of inflammation, statin use was associated solely with lower levels of soluble urokinase plasminogen activator receptor (suPAR) after adjusting for known confounders. In multivariable logistic regression analysis, statin use was associated with lower odds of the composite outcome (adjusted odds ratio (aOR) 0.63, 95% CI [0.53-0.76]) compared to patients not on statins. Findings were consistent with IPTW (aOR 0.92, 95% CI [0.89- 0.95]). The proportion of the effect of statin on the primary outcome mediated by suPAR was estimated at 31.5%.
Conclusion:
Prior-statin use is associated with improved outcomes and lower inflammation as measured by suPAR levels in patients hospitalized for COVID-19.
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