他汀类药物的使用与住院患者的 COVID-19 结局。
Statins use and COVID-19 outcomes in hospitalized patients.
机构信息
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
出版信息
PLoS One. 2021 Sep 10;16(9):e0256899. doi: 10.1371/journal.pone.0256899. eCollection 2021.
BACKGROUND
There is an urgent need for novel therapeutic strategies for reversing COVID-19-related lung inflammation. Recent evidence has demonstrated that the cholesterol-lowering agents, statins, are associated with reduced mortality in patients with various respiratory infections. We sought to investigate the relationship between statin use and COVID-19 disease severity in hospitalized patients.
METHODS
A retrospective analysis of COVID-19 patients admitted to the Johns Hopkins Medical Institutions between March 1, 2020 and June 30, 2020 was performed. The outcomes of interest were mortality and severe COVID-19 infection, as defined by prolonged hospital stay (≥ 7 days) and/ or invasive mechanical ventilation. Logistic regression, Cox proportional hazards regression and propensity score matching were used to obtain both univariable and multivariable associations between covariates and outcomes in addition to the average treatment effect of statin use.
RESULTS
Of the 4,447 patients who met our inclusion criteria, 594 (13.4%) patients were exposed to statins on admission, of which 340 (57.2%) were male. The mean age was higher in statin users compared to non-users [64.9 ± 13.4 vs. 45.5 ± 16.6 years, p <0.001]. The average treatment effect of statin use on COVID-19-related mortality was RR = 1.00 (95% CI: 0.99-1.01, p = 0.928), while its effect on severe COVID-19 infection was RR = 1.18 (95% CI: 1.11-1.27, p <0.001).
CONCLUSION
Statin use was not associated with altered mortality, but with an 18% increased risk of severe COVID-19 infection.
背景
目前迫切需要新的治疗策略来逆转与 COVID-19 相关的肺部炎症。最近的证据表明，降低胆固醇的药物他汀类药物与各种呼吸道感染患者的死亡率降低有关。我们试图调查他汀类药物使用与住院 COVID-19 患者疾病严重程度之间的关系。
方法
对 2020 年 3 月 1 日至 2020 年 6 月 30 日期间入住约翰霍普金斯医疗机构的 COVID-19 患者进行了回顾性分析。主要观察终点为死亡率和严重 COVID-19 感染，定义为住院时间延长（≥ 7 天）和/或有创机械通气。使用逻辑回归、Cox 比例风险回归和倾向评分匹配，除了他汀类药物使用的平均治疗效果外，还获得了协变量与结局之间的单变量和多变量关联。
结果
在符合纳入标准的 4447 名患者中，594 名（13.4%）患者入院时接受了他汀类药物治疗，其中 340 名（57.2%）为男性。与未使用者相比，他汀类药物使用者的平均年龄更高[64.9 ± 13.4 岁比 45.5 ± 16.6 岁，p <0.001]。他汀类药物使用对 COVID-19 相关死亡率的平均治疗效果为 RR = 1.00（95% CI：0.99-1.01，p = 0.928），而对严重 COVID-19 感染的效果为 RR = 1.18（95% CI：1.11-1.27，p <0.001）。
结论
他汀类药物使用与死亡率变化无关，但与严重 COVID-19 感染的风险增加 18%有关。
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