Effects of non-HDL-C and statin therapy on mortality in ARDS: a retrospective cohort study

Acute respiratory distress syndrome (ARDS) is a critical and potentially fatal condition marked by inflammation and coagulation disorders. Statins, a class of cholesterol-lowering medications, have been explored for potential anti-inflammatory properties, yet their exact role in ARDS remains unclear.

Patients diagnosed with ARDS were sourced from the MIMIC-IV database (version 3.0). To balance baseline characteristics, propensity score matching (PSM) was applied. Short-term mortality was evaluated using Kaplan-Meier survival analysis. Factors associated with short-term mortality were determined using both univariate and multivariate Cox regression analyses. The potential impact of unmeasured confounding was assessed using the E-value. Additionally, subgroup analyses were performed to investigate heterogeneity and evaluate the robustness of the findings.

The study included 10,368 ARDS patients, of whom 5,184 received statin therapy and 5,184 did not. Kaplan-Meier analysis revealed significantly lower short-term mortality in the statin-treated group. Both univariate (HR, 0.48; 95% CI, 0.41-0.58; p < 0.001) and multivariate (HR, 0.49; 95% CI, 0.41-0.58; p < 0.001) Cox regression analyses revealed that statin therapy significantly decreased short-term mortality. Subsequent subgroup analyses further indicated that the beneficial effect of statins was more evident in patients with elevated non-HDL-C levels.

Statin therapy appears to confer significant clinical benefits in ARDS patients, particularly in those with high non-HDL-C levels. These findings indicate that non-HDL-C might be a useful marker for identifying ARDS patients who may benefit most from statin therapy.