Community-acquired pneumonia (CAP) is the leading infectious cause of death in the United States. Recent studies suggest that cytokines play an important role in host defense mechanisms for patients with CAP but under certain conditions may lead to septic shock or acute respiratory distress syndrome. Several cardiac studies have demonstrated that statins blunt systemic inflammation due to cytokines however only one study has shown that statins are associated with improved outcomes in bacteremic patients. The primary aim of this study is to examine the impact of outpatient statin use at presentation upon 90-day mortality for patients hospitalized with CAP.
A retrospective, observational study was conducted at two tertiary teaching. Eligible patients were admitted with a diagnosis of CAP between 1/1/1999 and 12/31/2001. All patients had a chest x-ray consistent with CAP, and had a discharge ICD-9 diagnosis of pneumonia. Patients were excluded if they were “comfort measures only” or transferred from another acute care hospital. Patients were stratified to severe-CAP and non-severe CAP groups using the Pneumonia Severity Index (PSI). A logistic regression analysis was performed using 30-day mortality as the dependent measure; and the PSI, concomitant statin use at presentation, and other potential confounders, as the independent variables.
Information was obtained on 787 patients with CAP. The median age was 60 years, 79% were male, and 20% were initially admitted to the ICU. By PSI, 55% were low risk, 32% were moderate risk, and 13% were high risk. Mortality was 13% at 90-days. Statins were used by 14% of patients at presentation. In the regression model, after adjusting for severity of illness and other confounders, statin use was associated with decreased mortality (OR 0.4, 95% CI 0.2-0.90).
Statin use at presentation was associated with decreased mortality in patients hospitalized with CAP.
Further study is needed to assess whether these medications have significant immunomodulatory or cardio-protective effects for patients with CAP.
M.I. Restrepo, None.