HMG-CoA还原酶抑制剂的使用对COVID-19危重症患者临床结局的影响：一项多中心队列研究。
The impact of HMG-CoA reductase inhibitors use on the clinical outcomes in critically ill patients with COVID-19: A multicenter, cohort study.
作者信息
Al Sulaiman Khalid, Aljuhani Ohoud, Korayem Ghazwa B, Altebainawi Ali F, Al Harbi Shmeylan, Al Shaya Abdulrahman, Badreldin Hisham A, Kensara Raed, Alharthi Abdullah F, Alghamdi Jahad, Alawad Ahad, Alotaibi Rand, Kharbosh Abdullah, Al Muqati Hessa, Alhuwahmel Abdulmohsen, Almusallam Mohammed, Albarrak Ghada, Al Sulaihim Ibrahim, Alanazi Bader, Al-Dosari Bodoor S, Vishwakarma Ramesh, Alsaeedi Alawi S, Al Ghamdi Ghassan, Alkofide Hadeel, Al-Dorzi Hasan M
机构信息
Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
出版信息
Front Public Health. 2022 Aug 11;10:877944. doi: 10.3389/fpubh.2022.877944. eCollection 2022.
BACKGROUND
The cardiovascular complications of Coronavirus Disease 2019 (COVID-19) may be attributed to the hyperinflammatory state leading to increased mortality in patients with COVID-19. HMG-CoA Reductase Inhibitors (statins) are known to have pleiotropic and anti-inflammatory effects and may have antiviral activity along with their cholesterol-lowering activity. Thus, statin therapy is potentially a potent adjuvant therapy in COVID-19 infection. This study investigated the impact of statin use on the clinical outcome of critically ill patients with COVID-19.
METHODS
A multicenter, retrospective cohort study of all adult critically ill patients with confirmed COVID-19 who were admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on the statin use during ICU stay and were matched with a propensity score based on patient's age and admission APACHE II and SOFA scores. The primary endpoint was in-hospital mortality, while 30 day mortality, ventilator-free days (VFDs) at 30 days, and ICU complications were secondary endpoints.
RESULTS
A total of 1,049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality [hazard ratio 0.69 (95% CI 0.54, 0.89), = 0.004] and 30-day mortality [hazard ratio 0.75 (95% CI 0.58, 0.98), = 0.03] were significantly lower in patients who received statin therapy on multivariable cox proportional hazards regression analysis. Moreover, patients who received statin therapy had lower odds of hospital-acquired pneumonia [OR 0.48 (95% CI 0.32, 0.69), < 0.001], lower levels of inflammatory markers on follow-up, and no increased risk of liver injury.
CONCLUSION
The use of statin therapy during ICU stay in critically ill patients with COVID-19 may have a beneficial role and survival benefit with a good safety profile.
背景
2019冠状病毒病（COVID-19）的心血管并发症可能归因于炎症反应过度，导致COVID-19患者死亡率增加。已知羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）具有多效性和抗炎作用，并且除了其降胆固醇活性外可能还具有抗病毒活性。因此，他汀类药物治疗可能是COVID-19感染中一种有效的辅助治疗方法。本研究调查了他汀类药物的使用对重症COVID-19患者临床结局的影响。
方法
一项多中心回顾性队列研究，研究对象为2020年3月1日至2021年3月31日期间入住重症监护病房（ICU）的所有确诊为COVID-19的成年重症患者。符合条件的患者根据ICU住院期间是否使用他汀类药物分为两组，并根据患者年龄、入院时急性生理学与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分进行倾向得分匹配。主要终点是住院死亡率，次要终点是30天死亡率、30天时无呼吸机天数（VFDs）和ICU并发症。
结果
共有1049例患者符合条件；倾向得分匹配（1:1比例）后纳入502例患者。在多变量Cox比例风险回归分析中，接受他汀类药物治疗的患者住院死亡率[风险比0.69（95%置信区间0.54，0.89），P = 0.004]和30天死亡率[风险比0.75（95%置信区间0.58，0.98），P = 0.03]显著降低。此外，接受他汀类药物治疗的患者医院获得性肺炎的几率较低[比值比0.48（95%置信区间0.32，0.69），P < 0.001]，随访时炎症标志物水平较低，且肝损伤风险未增加。
结论
在重症COVID-19患者的ICU住院期间使用他汀类药物治疗可能具有有益作用和生存益处，且安全性良好。
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