住院的 2019 冠状病毒病患者中，美国大型队列研究中发病前使用他汀类药物的有益作用。
Beneficial effects of prehospital use of statins in a large United States cohort of hospitalized coronavirus disease 2019 patients.
机构信息
Department of Anesthesiology.
Department of Surgery, College of Medicine, University of Central Florida, Orlando, FL, USA; Ocala Health, Ocala.
出版信息
J Cardiovasc Med (Hagerstown). 2023 Mar 1;24(3):172-183. doi: 10.2459/JCM.0000000000001441.
AIMS
This large cohort study aimed to assess the role of chronic statin use on COVID-19 disease severity.
METHODS
An observational retrospective study from electronic medical records of hospitalized patients (n = 43 950) with COVID-19 between January and September 2020 in 185 hospitals in the United States. A total of 38 875 patients met inclusion criteria; 23 066 were included in the propensity-matched sampling with replacement cohort; 11 533 were prehospital statin users. The primary outcome was all-cause death; secondary outcomes were death from COVID-19 and serious complications. Mean, standard deviation, chi-square test, Student's t-test, linear regression, and binary and multinomial logistic regressions were used for statistical analysis.
RESULTS
Among 38 875 patients, 30% were chronic statin users [mean age, 70.82 (±12.25); 47.1% women] and 70% were statin nonusers [mean age, 58.44 (±18.27); 48.5% women]. Key propensity-matched outcomes among 11 533 chronic statin users showed 20% lower risk of all-cause mortality (OR 0.80, 95% CI 0.74-0.86, P < 0.001), 23% lower risk of mortality from COVID-19 (OR 0.77, 95% CI 0.71-0.84, P < 0.001), 16% lower risk of ICU admission (OR 0.84, 95% CI 0.79-0.89, P < 0.001), 24% lower risk of critical acute respiratory distress syndrome with COVID-19 (OR 0.76, 95% CI 0.70-0.83, P < 0.001), 23% lower risk of mechanical ventilation (OR 0.77, 95% CI 0.71-0.82, P < 0.001), 20% lower risk of severe sepsis with septic shock (OR 0.80, 95% CI 0.67-0.93, P = 0.004), shorter hospital length of stay [9.87 (±8.94), P < 0.001] and brief duration of mechanical ventilation [8.90 (±8.94), P < 0.001].
CONCLUSION
Chronic use of statins is associated with reduced mortality and improved clinical outcomes in patients hospitalized for COVID-19.
目的
本大规模队列研究旨在评估慢性他汀类药物使用与 COVID-19 疾病严重程度的关系。
方法
这是一项在美国 185 家医院进行的电子病历回顾性观察研究，纳入了 2020 年 1 月至 9 月期间 COVID-19 住院患者（n=43950）。共有 38875 名患者符合纳入标准；23066 名患者被纳入倾向评分匹配的替换队列；11533 名为院前他汀类药物使用者。主要结局为全因死亡；次要结局为 COVID-19 死亡和严重并发症。采用均值、标准差、卡方检验、学生 t 检验、线性回归、二项式和多项逻辑回归进行统计分析。
结果
在 38875 名患者中，30%为慢性他汀类药物使用者（平均年龄 70.82±12.25 岁；47.1%为女性），70%为他汀类药物非使用者（平均年龄 58.44±18.27 岁；48.5%为女性）。在 11533 名慢性他汀类药物使用者中，关键的倾向性匹配结局显示全因死亡率降低 20%（OR 0.80，95%CI 0.74-0.86，P<0.001），COVID-19 死亡率降低 23%（OR 0.77，95%CI 0.71-0.84，P<0.001），重症监护病房（ICU）入住率降低 16%（OR 0.84，95%CI 0.79-0.89，P<0.001），COVID-19 合并危重症急性呼吸窘迫综合征（ARDS）的发生率降低 24%（OR 0.76，95%CI 0.70-0.83，P<0.001），机械通气率降低 23%（OR 0.77，95%CI 0.71-0.82，P<0.001），严重脓毒症合并感染性休克的发生率降低 20%（OR 0.80，95%CI 0.67-0.93，P=0.004），住院时间缩短[9.87（±8.94），P<0.001]，机械通气时间缩短[8.90（±8.94），P<0.001]。
结论
慢性使用他汀类药物与 COVID-19 住院患者的死亡率降低和临床结局改善相关。
Zotero 插件