Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

Abstract

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p < 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p < 0.001] and ICU LOS [mean difference −0.51(−0.79, −0.24); p < 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1.Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

The impact of statin use before intensive care unit admission on patients with acute kidney injury after cardiac surgery

“…A retrospective cohort study demonstrated that the risk of early mortality after primary coronary artery bypass graft surgery was reduced by preoperative statin therapy ( Pan et al, 2004 ). Although there was some research on whether pre-ICU statin use can improve the mortality of patients with AKI ( Tu et al, 2021 ) and sepsis ( Chinaeke et al, 2021 ) in the MIMIC database, there is no research on CSA-AKI patients. We mainly studied whether using statins in the pre-ICU is related to the clinical outcome of patients with CSA-AKI and whether it can reduce mortality.…”

“…Patients who met the following criteria were included in the study: 1) first ICU and first hospital admission; 2) hospital stay >48 h; and 3) patients undergoing cardiac surgery during hospitalization and diagnosed with AKI within 1 week after surgery. We excluded patients with preoperative AKI, ESKD, with statins use after admission but without statins before admission ( Tu et al, 2021 ), and aged <18 years. Finally, 675 pre-ICU statin users and 2095 non-users were enrolled in this study ( Figure 1 ), divided into groups pre-ICU statin use and non-use.…”

“…In addition, the simplified acute physiology score II (SAPS II), the sequential organ failure assessment (SOFA) score, the charlson comorbidity index (CCI) score, and In-hospital procedures such as hemodialysis and ventilation were collected. Because of many missing total cholesterol data, we referred to other literature to delete it ( Tu et al, 2021 ).…”

“…Several randomized controlled trials have shown that preoperative statin therapy can decrease postoperative atrial fibrillation (AF) ( Patti et al, 2006 ), major adverse cardiovascular and cerebrovascular events (MACCE) after surgery ( Xia et al, 2015 ), myocardial necrosis and short hospital stay ( Patti et al, 2006 ). In addition, some studies have reported that statins involved in neuroprotection ( Kivipelto et al, 2005 ), immunomodulation ( Greenwood et al, 2006 ) and cellular senescence ( Brouilette et al, 2007 ) may reduce the incidence of AKI ( Tu et al, 2021 ). A multicenter prospective cohort study demonstrated that statins might prevent CSA-AKI by detecting the decreased biomarkers of renal injury ( Molnar et al, 2014 ).…”

“…Billings reported that a reduction in CSA-AKI is associated with early postoperative statin use ( Billings et al, 2010 ). Moreover, several studies have demonstrated that in patients with sepsis ( Chinaeke et al, 2021 ) and AKI ( Tu et al, 2021 ), pre-ICU statin use was associated with decreased mortality during the ICU and admission. Although several studies have supported the improvement of statins, others did not ( Park et al, 2016 ; Zheng et al, 2016 ).…”