Majumdar SR, McAlister FA, Eurich DT, Padwal RS, Marrie TJ.

Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study

OBJECTIVES: To determine whether statins reduce mortality or need for admission to intensive care in patients admitted to hospital with community acquired pneumonia; and to assess whether previously reported improvements in sepsis related outcomes were a result of the healthy user effect. DESIGN: Population based prospective cohort study. SETTING: Six hospitals in Capital Health, Edmonton, Alberta, Canada. PARTICIPANTS: Adults admitted to hospital with pneumonia and categorised according to use of statins for at least one week before admission and during hospital stay. MAIN OUTCOME MEASURES: Composite of in-hospital mortality or admission to an intensive care unit. RESULTS: Of 3415 patients with pneumonia admitted to hospital, 624 (18%) died or were admitted to an intensive care unit. Statin users were less likely to die or be admitted to an intensive care unit than non-users (50/325 (15%) v 574/3090 (19%), odds ratio 0.80, P=0.15). After more complete adjustment for confounding, however, the odds ratios changed from potential benefit (0.78, adjusted for age and sex) to potential harm (1.10, fully adjusted including propensity scores, 95% confidence interval 0.76 to 1.60). CONCLUSIONS: Statins are not associated with reduced mortality or need for admission to an intensive care unit in patients with pneumonia; reports of benefit in the setting of sepsis may be a result of confounding.