CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain.
Universitat Rovira i Virgili, Statistics Department, Institut Investigació Sanitaria Pere Virgili, Reus, Spain.
Eur Heart J Cardiovasc Pharmacother. 2022 Feb 16;8(2):157-164. doi: 10.1093/ehjcvp/pvaa128.
Assessing the effect of statin therapy (ST) at hospital admission for COVID-19 on in-hospital mortality.
Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients [1234 men, 923 women; age: 67 y/o (IQR 54-78)] admitted to the hospital were retrieved from the clinical records in anonymized manner. Three hundred and fifty-three deaths occurred. Five hundred and eighty-one patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on ST than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: P = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared with the GM non-statin group (17.4%; P = 0.045). The Cox model applied to the CSH function [HR = 0.58(CI: 0.39-0.89); P = 0.01] and the competing-risks FG model [HR = 0.60 (CI: 0.39-0.92); P = 0.02] suggest that statins are associated with reduced COVID-19-related mortality.
A lower SARS-CoV-2 infection-related mortality was observed in patients treated with ST prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.
评估 COVID-19 住院时使用他汀类药物(ST)治疗对住院死亡率的影响。
回顾性观察性研究。服用他汀类药物的患者比未服用他汀类药物的患者年长 11 岁,且合并症明显更多。在分析死亡率风险之前,进行了基因匹配(GM)程序。使用 Cox 比例风险模型进行特定原因的危险(CSH)函数分析,并且还使用竞争风险 Fine 和 Gray(FG)模型来研究他汀类药物对风险的直接影响。从临床记录中以匿名方式检索了 2157 名经逆转录-聚合酶链反应确认的 SARS-CoV-2 感染患者[1234 名男性,923 名女性;年龄:67 岁(IQR 54-78)]的数据。发生了 353 例死亡。581 名患者服用他汀类药物。GM 后单变量检验显示,接受 ST 治疗的患者死亡率明显低于匹配的非他汀类药物组(19.8%比 25.4%,经 Yates 连续性校正的卡方检验:P=0.027)。与 GM 非他汀类药物组相比,住院期间继续服用他汀类药物的患者(n=336)的死亡率更低(17.4%;P=0.045)。应用于 CSH 函数的 Cox 模型[HR=0.58(CI:0.39-0.89);P=0.01]和竞争风险 FG 模型[HR=0.60(CI:0.39-0.92);P=0.02]表明,他汀类药物与降低 COVID-19 相关死亡率相关。
在住院前接受 ST 治疗的患者中,观察到与 SARS-CoV-2 感染相关的死亡率较低。不应因全球对大流行的担忧或因 COVID-19 住院而停止他汀类药物治疗。