Elsevier

The American Journal of Medicine

Volume 121, Issue 11, November 2008, Pages 1002-1007.e1
The American Journal of Medicine

Clinical research study
Prior Statin Use Is Associated with Improved Outcomes in Community-acquired Pneumonia

https://doi.org/10.1016/j.amjmed.2008.06.030Get rights and content

Abstract

Background

Statins have potent anti-inflammatory effects in laboratory studies of pulmonary inflammation. We investigated whether statin users had improved outcome when admitted with community-acquired pneumonia.

Methods

We carried out a prospective observational study of patients admitted to the hospital with community-acquired pneumonia between January 2005 and November 2007. The use of statins, angiotensin-converting enzyme inhibitors, beta-blockers, and aspirin were recorded. The outcomes of interest were 30-day mortality, need for mechanical ventilation or inotropic support, and the development of complicated pneumonia.

Results

On multivariate logistic regression, statin use was associated with significantly lower 30-day mortality (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI], 0.25-0.85, P = .01) and development of complicated pneumonia (AOR 0.44, 95% CI, 0.25-0.79, P = .006). There was no effect on requirement of mechanical ventilation or inotropic support (AOR 0.93, 95% CI, 0.49-1.76, P = .8). Patients prescribed statins had more severe pneumonia (median Pneumonia Severity Index 4, interquartile range [IQR] 3-4) compared with patients not prescribed cardiovascular drugs (median Pneumonia Severity Index 3, IQR 2-4, P < .0001). Despite this, C-reactive protein levels on admission were significantly lower in patients prescribed statins (median 119 mg/L, IQR 46-215) compared with patients prescribed no cardiovascular drugs (182 mg/L, IQR 66-326, P < .0001). On multivariate logistic regression, statin use was independently protective against a C-reactive protein that failed to fall by 50% or more at day 4 (AOR 0.50, 95% CI 0.27-0.92, P = .02).

Conclusions

Statin use is associated with reduced markers of systemic inflammation and improved outcomes in patients admitted with community-acquired pneumonia.

Section snippets

Methods

The authors conducted a prospective observational study of consecutive unselected patients admitted with radiologically confirmed community-acquired pneumonia to NHS Lothian University Hospitals Division (Edinburgh, United Kingdom) between January 2005 and November 2007. The study was approved by the Lothian Research Ethics Committee.

Patients were included in the study if they presented with a new infiltrate on a chest radiograph and had 3 or more of the following symptoms or signs: cough,

Results

The study included 1007 patients with community-acquired pneumonia. The frequency of prescription of cardiovascular drugs were as follows: aspirin: 311 patients; statins: 257 patients (Simvastatin: 185 patients; atorvastatin: 55 patients; pravastatin: 17 patients); ACE inhibitors or angiotensin II receptor antagonists: 167 (Ramipril: 61 patients; Lisinopril: 49 patients; Perindopril: 22 patients; Trandolapril: 3 patients; Captopril: 1 patient; Losartan: 17 patients; Candesartan: 10 patients;

Discussion

Statin use is associated with a significant reduction in 30-day mortality from community-acquired pneumonia, confirming the findings of a previous retrospective study.4 In addition, statin use is associated with a reduced risk of development of complicated parapneumonic effusion or empyema as a complication of community-acquired pneumonia. This is a finding that has not previously been reported. The authors found no benefit from the prescription of aspirin, ACE inhibitors, or angiotensin II

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