Abstract
BackgroundStatins are drugs that are used to lower plasma cholesterol levels. Recently, contradictory claims have been made about possible additional effects of statins on progression of a variety of inflammatory disorders, including infections. We therefore examined the clinical course of patients admitted to hospital with 2009 pandemic influenza A(H1N1), who were or weren't taking statins at time of admission.MethodsA retrospective case-control study was performed using the United Kingdom Influenza Clinical Information Network (FLU-CIN) database, containing detailed information on 1,520 patients admitted to participating hospitals with confirmed 2009 pandemic influenza A(H1N1) infection between April 2009 and January 2010. We confined our analysis to those aged over 34 years. Univariate analysis was used to calculate unadjusted odds ratios (OR) and 95 percent confidence intervals (95%CI) for factors affecting progression to severe outcome (high dependency or intensive care unit level support) or death (cases); two multivariable logistic regression models were then established for age and sex, and for age, sex, obesity and “indication for statin” (e.g., heart disease or hypercholesterolaemia).ResultsWe found no statistically significant association between pre-admission statin use and severity of outcome after adjustment for age and sex [adjusted OR: 0.81 (95% CI: 0.46–1.38); n = 571]. After adjustment for age, sex, obesity and indication for statin, the association between pre-admission statin use and severe outcome was not statistically significant; point estimates are compatible with a small but clinically significant protective effect of statin use [adjusted OR: 0.72 (95% CI: 0.38–1.33)].ConclusionsIn this group of patients hospitalized with pandemic influenza, a significant beneficial effect of pre-admission statin use on the in-hospital course of illness was not identified. Although the database from which these observations are derived represents the largest available suitable UK hospital cohort, a larger study would be needed to confirm whether there is any benefit in this setting.
Highlights
In March 2009 the first human cases of a novel strain of pandemic influenza A(H1N1; hereafter pH1N1) virus of swine origin were reported from the United States; within three months global spread had occurred leading to the declaration of a pandemic by the World Health Organization
There is a body of circumstantial evidence that current treatment with statins may beneficially alter the natural history of infectious diseases, reducing the likelihood of significant bacterial infection progressing to severe sepsis and septic shock [5,6,7]
Women appeared to be at a lower risk of severe outcome than men [crude odds ratios (OR): 0.45]
Summary
In March 2009 the first human cases of a novel strain of pandemic influenza A(H1N1; hereafter pH1N1) virus of swine origin were reported from the United States; within three months global spread had occurred leading to the declaration of a pandemic by the World Health Organization. Statins (three- hydroxy 3- methylgluteryl co enzyme A reductase inhibitors) are drugs indicated for control of plasma cholesterol. They have wide-ranging down-regulatory effects on inflammatory and immune mechanisms. A quarter of adults admitted to hospital and included in the Influenza Clinical Information Network database during the pH1N1 pandemic had clinically or radiographically apparent pneumonia [9], and there are reports that just under one third of such pneumonia cases had bacterial co-infection [10,11,12]. We examined the clinical course of patients admitted to hospital with 2009 pandemic influenza A(H1N1), who were or weren’t taking statins at time of admission
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