The Impact of Statin Use on Sepsis Mortality: A Systematic Review and Meta-Analysis

Background and Objectives: Statins are among the most prescribed medications globally, primarily due to their potent lipid-lowering capabilities. This systematic review aims to identify, synthesize and evaluate current evidence regarding the potential protective effects of statins on sepsis mortality. Materials and Methods: A thorough and comprehensive database search was conducted in PubMed and Cochrane Library until 30 January 2025. Randomized control trials (RCTs) and cohort studies evaluating the effect of statin use on sepsis mortality were included. Risk-ratios (RRs) and 95% confidence intervals (CIs) were calculated. Statistical analysis and forest plot generation were performed using RevMan 5.4. Risk of bias was assessed using the RoB-2 and NOS tools. Results: A total of 49 studies were identified following application of the PRISMA guidelines. Of these, 16 studies were RCTs and 33 were cohort studies. The pooled analysis of RCTs demonstrated a non-significant 10% reduction in mortality in statin users (RR: 0.90, 95% CI 0.80-1.01). The pooled analysis of cohort studies showed that statin users have a 21% significantly reduced mortality risk (RR: 0.79, 95% CI 0.72-0.86). For the de novo statin users vs non-statin users, pooled analysis demonstrated a significant 25% reduction in mortality (RR: 0.75, 95% CI 0.69-0.81). The pooled analysis for the continuation of prior statin use vs discontinuation of statin use indicated 52% lower mortality in statin users who continued the use of statins (RR: 0.48, 95% CI 0.25-0.92). The pooled analysis of prior statin use and continuation of statins vs non-statin use revealed a significant 23% lower risk in statin users compared with non-statin users (RR: 0.77, 95% CI 0.69-086). Conclusions: According to our findings, statin use among septic patients is associated with a reduction in mortality, suggesting that statins may offer a beneficial therapeutic effect in the clinical setting. Clinicians may consider the continuation or potential incorporation of statin use as an additional regimen in the treatment of septic patients.