Statin use in cirrhotic patients with infectious diseases: A population-based study

Abstract

Background Recent studies have shown benefits of statins in patients with liver cirrhosis. However, it is still unknown if statins have a beneficial effect on the mortality of cirrhotic patients with bacterial infections. Methods The Taiwan National Health Insurance Database was searched, and 816 cirrhotic patients receiving statins with bacterial infections hospitalized between January 1, 2010 and December 31, 2013 were included in the study. A one-to-four propensity score matching was performed to select a comparison group based on age, sex, and comorbid disorders. Results The overall 30-day mortalities in statin and non-statin group were 5.3% and 9.8%, respectively (P = 0.001). After Cox regression modeling adjusting for age, sex, and comorbid disorders, the hazard ratio (HR) of statin use on 30-day mortality was 0.52 (95% confidence interval [CI]: 0.38–0.72, P<0.001). In subgroup analysis, the 30-day mortality effect of statin use was more pronounced in patients with pneumonia (HR = 0.34; 95% CI: 0.19–0.59; P<0.001) and bacteremia (HR = 0.55; 95% CI: 0.35–0.85; P = 0.008). Atovastatin (HR = 0.59; 95% CI: 0.37–0.93) and rosuvastatin (HR = 0.59; 95% CI: 0.36–0.98) were associated with a decreased 30-day mortality risk compared to patients not taking statins. Conclusions Statin use decreases the 30-day mortality of cirrhotic patients with bacteremia and pneumonia.

Biological and Psychological Factors Determining Neuropsychiatric Outcomes in COVID-19

“…A following step would be to test if anti-inflammatory interventions, in particular those that cross the blood-brain barrier (BBB) vs. those that do not cross the BBB, will normalize the effect of the hypersensitivity to stressors, in parallel with TSPO binding. Broadly prescribed treatments that have an immunomodulatory effect, such as statins, could be used, as they have been shown to have major benefits in reducing severe outcomes in severe infections [210][211][212][213][214][215][216][217] with advantageous effects of statins emerging from both pretreatment [210,211,213,214,216,217] as well as continuation [211][212][213]217] paradigms. Experimentally, statins have been shown to reduce microglia and astrocyte activation after controlled cortical impact injury [218].…”

Novel Anti-inflammatory Treatments in Cirrhosis. A Literature-Based Study

“…Clinical studies of the anti-portal hypertensive effects of statins have provided encouraging results in recently published trials ( 93 , 97 , 102 , 117 ), while other studies have reported a reduced risk of decompensation and death ( 89 , 90 , 92 , 94 ), and that statins might reduce the risk of infections in patients with cirrhosis ( 96 ). One study also described improved survival during infections among cirrhotic patients undergoing continuing treatment with statins ( 104 ). Human studies exploring anti-inflammatory mechanisms in cirrhosis should be highly encouraged.…”

“…Randomised clinical trials have investigated beneficial effects on clinical outcomes such as liver function, rebleeding from oesophageal varices, and survival (92)(93)(94), and one ongoing multi-centre trial is also prospectively investigating the potential reduction of hepatic decompensation (19). However, no human studies have explored anti-inflammatory mechanisms in detail; hence, the therapeutic effects of statins are not yet completely understood [for clinical endpoints in human studies (90,(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104) see Supplementary Table 2].…”

Protocol for systematic review and meta-analysis: impact of statins as immune-modulatory agents on inflammatory markers in adults with chronic diseases

“…33 Statins also reduced mortality in patients with cirrhosis with bacteraemia and pneumonia. 34 Additionally, a 2-year treatment period with atorvastatin was associated with milder disease progression in patients with relapsing-remitting multiple sclerosis. 35 However, a study by Birnbaum et al reported that disease progression was exacerbated by atorvastatin combined with beta interferon in patients with multiple sclerosis.…”