Clinical research study
Is Statin Use Associated with Reduced Mortality After Pneumonia? A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.amjmed.2012.04.011Get rights and content

Abstract

Objective

The objective of this study was to perform a systematic review and meta-analysis of the effects of statins on mortality following pneumonia.

Methods

We searched MEDLINE, EMBASE, BIOSIS, Cochrane CENTRAL Register of Controlled Trials, Cambridge Scientific Abstracts, BIOSIS, and Scopus. Studies were included if they involved: participants ā‰„18 years of age; patients with community-acquired pneumonia; current statin users; and reported overall or adjusted mortality after pneumonia.

Results

Of 491 citations identified, 13 studies involving 254,950 patients met eligibility criteria. Pooled unadjusted data showed that statin use was associated with lower mortality after pneumonia (odds ratio [OR] 0.62, 95% confidence interval [CI], 0.54-0.71). Pooling of adjusted data also showed reduced mortality after pneumonia (OR 0.66, 95% CI, 0.55-0.79). However, this effect was attenuated in subgroup analysis by confounders and in prospective studies.

Conclusions

Although statin use is associated with decreased mortality after pneumonia, this effect weakens in important subgroups. Only a randomized controlled study can fully explore the link between statins and pneumonia mortality.

Section snippets

Information Sources and Search Strategy

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations in conducting this meta-analysis.12, 13 With the assistance of a medical research librarian, we performed serial literature searches for English and non-English articles. MEDLINE via PubMed (1950-present), EMBASE (1946-present), BIOSIS (1926-present), the Cochrane CENTRAL Register of Controlled Trials, and the Cochrane

Studies Included in the Systematic Review

Thirteen studies involving 254,950 patients published between 2005 and 2011 met inclusion criteria (Figure 1).14, 17, 18, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 The eligible studies varied in design and included 10 cohort studies (3 prospective,24, 28, 33 7 retrospective17, 18, 25, 27, 29, 30, 32), 2 case-control studies,26, 31 and one randomized trial14 available in abstract format only (Tables 1, 2). Sample sizes of the included studies ranged from 67 to 121,254 patients. The studies were

Discussion

This meta-analysis of 13 studies finds that current statin users are less likely to die after an episode of bacterial pneumonia compared with nonstatin users. The magnitude of this benefit was similar using both unadjusted and adjusted estimates. In both analyses, the observed mortality benefit was greatest at the 30-day interval, a time-point that has been invoked as being most correlated with mortality from pneumonia.34 However, this protective effect weakened when subgroups accounting for

Acknowledgements

The authors acknowledge Drs. Dublin (Group Health Center for Health Studies and Department of Epidemiology, University of Washington, Seattle, WA), Douglas (Faculty of Epidemiology & Population Health London School of Hygiene & Tropical Medicine, London, UK), Majumdar (Department of Medicine, University of Alberta, Edmonton, AB, Canada), Meier (Basel Pharmacoepidemiology Unit, University Hospital Basel, Switzerland), and Rothberg (Center for Quality of Care Research, Baystate Medical Center,

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    Funding: None.

    Conflict of Interest: None.

    Authorship: All authors had access to the data, participated in the conception, design, writing, editing, and final approval of the manuscript.

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