Abstract
In addition to cholesterol lowering properties, statins (hydroxymethyl glutaryl coenzyme-A reductase inhibitors) have anti-inflammatory and pleiotropic effects in infection which may result in clinical and economic benefits. Pleiotropic effects of statins are controversial, and evidence is limited among the ICU population. This study seeks to understand the impact of pre-ICU statin use on sepsis-related mortality and length of stay (LOS) in days. This study is a single-center retrospective cohort study of sepsis patients admitted to a major tertiary referral hospital ICU from 2002 to 2012. Pre-ICU statin users were matched to non-statin users using greedy 1:1 propensity score matching technique. Multivariate logistic regression and negative binomial regression were used to estimate odds ratios and natural log of LOS, respectively. Avoided costs due to reduced LOS was determined by estimating the product of the (i) percentage LOS reduction, (ii) average LOS and (iii) average cost of ICU stay pay day. Sensitivity analysis was performed using inverse probability of treatment weighting using the propensity score. A total of 10,129 eligible sepsis patients were identified, and a matched population of statin users (n=1,470) and non-statin users (n=1,470) were obtained. Most patients were white (75.7%) and aged 80 years and above (54.8 %). After adjusting for covariates, pre-ICU statin use was associated with lower odds of ICU-related mortality compared to non-statin use (aOR 0.81; 95% CI: 0.68 – 0.96). After adjusting for other covariates, pre-ICU statin use was associated with shorter LOS by 24% (Coefficient: -0.1272; 95% CI: -0.1996, -0.0549) compared to non-statin users, resulting in a potential cost avoidance of $5,381 per ICU admission per patient Among sepsis patients, pre-ICU statin use was associated with lower odds of mortality resulting in potential cost avoidance of $5,381 per ICU admission.
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