Abstract
BackgroundEmerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications.PurposePerformed a systematic review to address the role of statins in the prevention or treatment of CAP.Data SourceOvid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies.Study SelectionTwo authors independently reviewed studies that examined the role of statins in CAP.Data ExtractionData about study characteristics, adjusted effect-estimates and quality characteristics was extracted.Data SynthesisEighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74–0.95), I2 = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59–0.78), I2 = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77–0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder.ConclusionsOur meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias.
Highlights
The incidence of community-acquired pneumonia (CAP) ranges between 3 and 40 per 1000 inhabitants per year with estimated rates of hospitalization and overall mortality of 40–60% and 10%, respectively [1]
Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP
One study [40] did not distinguish the cause of death, but was included in the analysis as previous studies have reported that the 30-day mortality is primarily due to CAP rather than other causes [3,4]
Summary
The incidence of community-acquired pneumonia (CAP) ranges between 3 and 40 per 1000 inhabitants per year with estimated rates of hospitalization and overall mortality of 40–60% and 10%, respectively [1]. Several factors have been postulated for the adverse outcomes in CAP including acute lung injury (ALI), vascular dysfunction and coagulopathy due to a dysregulated inflammatory response caused by invading microorganisms. Statins have pleiotropic effects – immunomodulatory [12], antiinflammatory, anti-thrombotic [13] and a direct microbicidal action [14]; all of which may have potential beneficial role in the prevention and treatment of CAP. Data Synthesis: Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77–0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder
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