Impact of in-hospital statin use on mortality in COVID-19 patients from a majority African American population

• Published in: Heart & lung Vol. 64; pp. 137 - 141
• Main Authors: Sood, Nitish, Shukla, Dhairya, Mishra, Pranjal, Sharma, Saloni, Gandhi, Sahil, Linder, Daniel F., Shah, Priyank
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024; Published by Elsevier Inc
• Subjects: Cardiovascular; Emergency medicine; Evidence-based medicine; Infectious diseases; Intubation; Length of stay; Lipids; Outcomes research; Infectious diseases; Cardiovascular; Emergency medicine; Lipids; Intubation; Outcomes research; Evidence-based medicine; Length of stay
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2023.03.005

•As of August 18th, 2022, the COVID-19 pandemic has claimed over 6,400,000 lives worldwide and over 1,000,000 lives in the United States.•Prior retrospective studies exist in the literature, documenting that statins have a mortality benefit in patients hospitalized with COVID-19. These studies have focused on populations with a high proportion of Caucasians.•This retrospective study examines a population that is majority African American and found no benefit of statins in patients hospitalized with COVID-19 in mortality, survival time, need for ICU care, length of ICU stay, need for ventilator, duration of intubation, or need for dialysis.•Further research should be done examining the interplay between COVID-19, statins, and race/ethnicity to better elucidate whether statins have any beneficial effect in decreasing mortality caused by COVID-19. The COVID-19 pandemic has claimed over 6.4 million lives globally. Finding effective medications to reduce mortality in hospitalized COVID-19 patients remains critical. No previous study has been published on the effects of statin use in a majority African American COVID-19 patient population. This study aims to assess the relationship between in-hospital statin use and mortality in this population. A retrospective chart review of patients diagnosed with COVID-19 from March 2020 to June 2020 admitted to the Phoebe Putney Health System in Albany, Georgia, an early epicenter of the COVID-19 pandemic, was conducted. The outcomes of 735 hospitalized COVID-19 positive patients from over 40 counties in Georgia were analyzed. The primary outcome of interest was all-cause mortality, with secondary outcomes of interest of ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis. Multivariate logistic regression and Cox proportional hazards analysis were conducted to examine the effect of in-hospital statin use and mortality. 186 of 735 total patients were prescribed statins in-hospital. 83.8% were African American. Multivariate logistic regression found in-hospital statin use was not significantly associated with the primary outcome – all-cause mortality (p=0.23). Similar findings were seen in need for ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis (p>0.05). Additionally, results from a Cox proportional hazards model found in-hospital statin use was not associated with survival time. Sensitivity analysis conducted on only African American patients validated that in-hospital statin use was not associated with all-cause mortality in these patients. Of note, immunosuppression and severe disease presentation were associated with a six-fold increase in risk of mortality and the largest decreases in survival time. It is possible statins have no mortality benefit for this patient population, but further research beyond this association study would need to be conducted to determine this conclusively. From this study, the best clinical recommendation would be to continue statins for COVID-19 patients with pre-hospital statin use and to launch a randomized clinical trial to definitively determine the efficacy of statins in the treatment of hospitalized COVID-19 patients.