Abstract
Background: A large number of studies have been conducted to determine whether there is an association between preadmission statin use and improvement in outcomes following critical illness, but the conclusions are quite inconsistent. Therefore, this meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients.Methods: The PubMed, Web of Science, Embase electronic databases, and printed resources were searched for English articles published before March 6, 2020 on the association between preadmission statin use and mortality in critically ill patients. The included articles were analyzed in RevMan 5.3. The Newcastle-Ottawa Scale (NOS) was used to conduct quality evaluation, and random/fixed effects modeling was used to calculate the pooled ORs and 95% CIs. We also conducted subgroup analysis by outcome indicators (30-, 90-day, hospital mortality).Results: All six PSM observational studies were assessed as having a low risk of bias according to the NOS. For primary outcome—overall mortality, the pooled OR (preadmission statins use vs. no use) across the six included studies was 0.86 (95% CI, 0.76–0.97; P = 0.02). For secondary outcome—use of mechanical ventilation, the pooled OR was 0.94 (95% CI, 0.91–0.97; P = 0.0005). The corresponding pooled ORs were 0.67 (95% CI, 0.43–1.05; P = 0.08), 0.91 (95% CI, 0.83–1.01; P = 0.07), and 0.86 (95% CI, 0.83–0.89; P < 0.00001) for 30-, 90-day, and hospital mortality, respectively.Conclusions: Preadmission statin use is associated with beneficial outcomes in critical ill patients, indicating a lower short-term mortality, less use of mechanical ventilation, and an improvement in hospital survival. Further high-quality original studies or more scientific methods are needed to draw a definitive conclusion.
Highlights
Statins, which inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, are a typical class of medications commonly used for lowering cholesterol levels
We included original studies only if they met the following inclusion criteria: [1] Study design: studies analyzed by propensity score matching (PSM); [2] Study population: critically ill adult patients (>18 years of age), who were defined as patients admitted to an intensive care unit (ICU)
When this information was unclear, we considered a mortality rate higher than 5% in the control group to be consistent with critical illness; [3] Intervention: critically ill patients who had preadmission statin use vs. those who didn’t; [4] Study outcomes: mortality should be the primary outcome of included studies, with the rate of mechanical ventilation use could be among the secondary outcomes
Summary
Statins, which inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, are a typical class of medications commonly used for lowering cholesterol levels. There has been substantial evidence proving that statins can play important roles in preventing cardiovascular events and improving patients’ survival [1,2,3,4] Apart from this well-known therapeutic effect, statins may have other effects which are lipid-independent. These effects, generally referred to as pleiotropic properties, include anti-inflammatory actions, attenuation of coagulation activation, and immunomodulation [5, 6]. Ill patients, such as those who suffer from sepsis, end-stage cardiopulmonary diseases, or severe traumatic injuries, usually have a high prevalence of intensive care unit (ICU) admission and high risk for progression to adverse complications, leading to life-threatening outcomes. This meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients
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