Statin therapy did not improve the in-hospital outcome of coronavirus disease 2019 (COVID-19) infection

Hariyanto, Timotius Ivan; Kurniawan, Andree

doi:10.1016/j.dsx.2020.08.023

Cited by 81 publications

(98 citation statements)

References 14 publications

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“…In fact, the results using adjusted data confirm those reported in the meta-analysis by Kow et al [12] , who reported a 30% reduction in fatal or severe COVID-19 infection. On the other hand, the univariate analyses confirm the lack of significant protection among statin users reported in the meta-analysis by Hariyanto et al [13] .…”

Section: Discussionsupporting

confidence: 81%

“…Any resulting discrepancies were resolved by mutual discussion. The reference lists of previous systematic reviews and meta-analyses [12] , [13] and of any related narrative reviews or commentaries [16] , especially those involving diabetes populations [3] , [4] , were manually examined to identify any additional publications relevant to the present study. A search for duplicates was done manually.…”

Section: Methodsmentioning

confidence: 99%

“…Two previous meta-analyses of observational studies compared clinical outcomes in statin users vs non-users and gave conflicting results: one demonstrated a positive impact [12] , whereas the other failed to show any significant differences in prognosis [13] . Nevertheless, these meta-analyses were performed using a rather limited number of studies (some only available as preprints).…”

Section: Introductionmentioning

confidence: 99%

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Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Scheen

2021

Diabetes & Metabolism

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Aims People with cardiovascular disease or risk factors are at increased risk when exposed to SARS-CoV-2. Most are treated with statins, but the impact of these drugs on clinical outcomes of COVID-19 remains unclear. This report is therefore based on meta-analyses of retrospective observational studies aimed at investigating the impact of previous statin therapy in patients hospitalized for COVID-19. Methods In studies reporting on the clinical outcomes of COVID-19 in statin users vs non-users, two endpoints have been used—in-hospital death rates, and disease severity as assessed by admission to intensive care units (ICUs)—with a special focus on patients with diabetes. Results Regarding mortality, 13 studies were included in the meta-analysis for a total of 10,829 statin users (2517 deaths) and 31,893 non-users (7516 deaths): univariate analysis showed no statistically significant reduction in deaths (OR: 0.97, 95% CI: 0.92–1.03), although between-study heterogeneity was high (I² = 97%). As for disease severity, 11 studies were selected for a total of 3462 statin users (724 endpoints) and 10,560 non-users (1763 endpoints): here again, univariate analysis showed no reduction in severity (OR: 1.09, 95% CI: 0.99–1.22; I² = 93%). Collectively, in 10 studies using multivariable analysis adjusted for the more prevalent baseline risk factors among statin users, lower OR values were reported than with univariate analyses (0.73 ± 0.31 vs 1.44 ± 0.84, respectively; P = 0.0028; adjusted OR: P = 0.0237 vs non-users). Limited but conflicting findings were observed for diabetes patients. Conclusion Although no significant reductions in either in-hospital mortality or COVID-19 severity were reported among statin users compared with non-users after univariate comparisons, such reductions were observed after adjusting for confounding factors. These highly heterogeneous observational findings now require confirmation by ongoing randomized clinical trials.

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Section: Discussionsupporting

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Scheen

2021

Diabetes & Metabolism

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“…The results on statin use and its potential benefits for COVID-19 patients are controversial. In a recent meta-analysis, it was reported that “statin use did not improve in-hospital outcomes of COVID-19 infections” [ 39 ]; this analysis included 9 studies with a total of 3449 patients. The results showed that statin use did not improve the outcome severity [OR = 1.64, 95% CI: (0.51–5.23), P = 0.41, I2 = 93%, random-effect modelling] or the mortality rate associated with COVID-19 infection [OR 0.78, 95% CI: (0.50–1.21), p = 0.26, I2 = 0%, fixed-effect modelling] [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

et al. 2021

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Background The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93), P = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72), P = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61–2.99), P = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07–2.33), P = 0.312]. Conclusions Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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“…This abrupt onset of disease progression has contributed to an increase in the mortality rate of the disease. Several comorbidities have also been demonstrated to be associated with the development of severe COVID-19, such as hypertension, diabetes mellitus, dyslipidemia, thyroid disease, cardiovascular disease, dementia, and pulmonary disease [ [6] , [7] , [8] , [9] ]. Therefore, prompt identification and containment, which are achievable through strict surveillance and early diagnosis, are very important.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis

Hariyanto

Japar

Kwenandar

et al. 2021

The American Journal of Emergency Medicine

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175

139

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Background: Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease. Method: We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19. Results: There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05-0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10-44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31-0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10-126.49; p < 0.00001) but lower levels of albumin (mean difference −4.58; 95% CI −5.76 to −3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity. Conclusion: This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.

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Statin therapy did not improve the in-hospital outcome of coronavirus disease 2019 (COVID-19) infection

Cited by 81 publications

References 14 publications

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis

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