他汀类药物使用与 COVID-19 严重疾病结局的关联：一项基于倾向评分匹配的回顾性研究。

Association between antecedent statin use and severe disease outcomes in COVID-19: A retrospective study with propensity score matching.

机构信息

Department of Internal Medicine, Wayne State University, Detroit, MI, United States.

Wayne State University, Detroit, MI, United States.

出版信息

J Clin Lipidol. 2021 May-Jun;15(3):451-459. doi: 10.1016/j.jacl.2021.03.002. Epub 2021 Mar 6.

DOI:10.1016/j.jacl.2021.03.002

PMID:33726984

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7936125/

Abstract

BACKGROUND

Statins have been associated with a reduction in inflammatory markers and improved endothelial function. Whether statins offer any benefit in COVID-19 needs to be elucidated.

OBJECTIVE

To determine the association between antecedent statin use and severe disease outcomes among COVID-19 patients.

METHODS

A retrospective cohort study on 1014 patients with confirmed COVID-19 diagnosis. Outcomes were mortality, need for mechanical ventilation, and intensive care admission. Patients were classified into statin-users vs statin non-users based on antecedent use of statins. Multivariable regression analysis was performed adjusting for confounders such as age, sex, race, BMI, smoking, insurance, and comorbidities. Propensity score matching was performed to achieve a 1:1 balanced cohort.

RESULTS

A total of 1014 patients (Median age 65 (IQR 53-73); 530 (52.3%) males; 753 (74.3%) African Americans; median BMI 29.4 (IQR 25.1-35.9); 615 (60.7%) with Medicare insurance) were included in the study. About 454 patients (44.77%) were using statins as home medication. Antecedent statin use was associated with significant decrease in mortality in the total cohort (OR, 0.66; 95% CI, 0.46 - 0.95; p = 0.03). Among the propensity score matched (PSM) cohort of 466 patients (233 statin users and 233 statin non-users), all the baseline characteristics had similar distribution among the two groups. Statin users had significant reduction in mortality in the PSM cohort as well (OR, 0.56; 95% CI, 0.37 - 0.83; p = 0.004).

CONCLUSIONS

Statin use was associated with significant reduction in mortality among COVID-19 patients. These findings support the pursuit of randomized clinical trials to explore the possible benefits of statins in COVID-19.

摘要

背景

他汀类药物与炎症标志物的减少和内皮功能的改善有关。他汀类药物在 COVID-19 中的益处尚需阐明。

目的

确定 COVID-19 患者中使用他汀类药物与严重疾病结局之间的关系。

方法

对 1014 例确诊 COVID-19 患者进行回顾性队列研究。结局为死亡率、需要机械通气和入住重症监护病房。根据他汀类药物的使用情况，将患者分为他汀类药物使用者和非使用者。采用多变量回归分析调整年龄、性别、种族、BMI、吸烟、保险和合并症等混杂因素。采用倾向评分匹配（propensity score matching）实现 1:1 平衡队列。

结果

共纳入 1014 例患者（中位年龄 65（IQR 53-73）；530 例（52.3%）男性；753 例（74.3%）非裔美国人；中位 BMI 29.4（IQR 25.1-35.9）；615 例（60.7%）有医疗保险）。约 454 例患者（44.77%）正在服用他汀类药物作为家庭用药。在总队列中，他汀类药物的使用与死亡率显著降低相关（OR，0.66；95%CI，0.46 - 0.95；p=0.03）。在 466 例（233 例他汀类药物使用者和 233 例非他汀类药物使用者）的倾向评分匹配（PSM）队列中，两组的所有基线特征分布相似。在 PSM 队列中，他汀类药物使用者的死亡率也显著降低（OR，0.56；95%CI，0.37 - 0.83；p=0.004）。