Newly Published
Critical Care Medicine  |   June 2019
Preadmission Statin Use and 90-day Mortality in the Critically Ill: A Retrospective Association Study
Author Notes
  • From the Department of Anesthesiology and Pain Medicine (T.K.O., I.-A.S., Y.-T.J.), the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.H.L.), the Department of Thoracic and Cardiovascular Surgery (C.L.), the Department of Neurology, Stroke Center (H.-J.B.), and the Department of Emergency Medicine (Y.H.J.), Seoul National University Bundang Hospital, Seongnam, Korea; and the Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (H.-J.J.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication July 31, 2018. Accepted for publication April 23, 2019.
    Submitted for publication July 31, 2018. Accepted for publication April 23, 2019.×
  • Correspondence: Address correspondence to Dr. Oh: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. airohtak@hotmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Cardiovascular Anesthesia / Critical Care
Critical Care Medicine   |   June 2019
Preadmission Statin Use and 90-day Mortality in the Critically Ill: A Retrospective Association Study
Anesthesiology Newly Published on June 19, 2019. doi:10.1097/ALN.0000000000002811
Anesthesiology Newly Published on June 19, 2019. doi:10.1097/ALN.0000000000002811
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Randomized controlled trials evaluating the potential value of statin administration for intensive care unit patients have not observed a benefit

  • However, the chronic preadmission use of statins among patients admitted to the intensive care unit has not been robustly studied

What This Article Tells Us That Is New:

  • Single-center retrospective data suggest that preadmission statin use may be associated with decreased 90-day mortality among some intensive care unit patients

  • Specific statin agents and noncardiovascular mortality may demonstrate a stronger signal for further study

Background: This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality.

Methods: This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality.

Results: A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use.

Conclusions: Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.