Statins and mortality risk in hospitalized community acquired pneumonia patients

ABSTRACT

Rationale Statins, anti-hypertensives, Proton pump inhibitors (PPIs) and H2 receptor antagonist (H2RAs) are amongst the most commonly prescribed medications for adults over the age of 50 (Kantor et al, 2015). PPI use was recently reported to have worse clinical outcomes during the COVID-19 pandemic (Lee et al, 2020). Before COVID-19, PPI use was associated with an increased risk of community acquired pneumonia (CAP) (Hertzig et al, 2009;Othman et al, 2016;Zirk-Sadowski et al, 2018). In this study, we examined the mortality risk associated with these four medications in hospitalized CAP patients not due to novel SARS-CoV-2 infection. Methods: We analyzed de-identified patient data from a research database of 6 hospitals in an integrated tertiary university healthcare system from January 1 to December 31, 2019. ICD-10 codes for CAP at the time of hospital admission were used to identify patients. A list of 17 variables relevant to outcome of CAP including demographic, comorbid conditions and medications of interests were extracted. Statistical analysis included Wilcoxon rank-sum tests, chi-squared tests, and multivariable logistic regression models were used to assess the mortality risk of all the factors. Results: Of 1223 patients admitted with CAP, the overall mortality rate was 19.9% (243/1223), baseline characteristics are shown in Table 1. There were 613 (50%) patients on PPIs, 551 (45%) on anti-hypertensives, 276 (23%) on H2RAs, and 271 (22%) on statins. PPI users had a mortality rate of 26.3% (161/613) vs 13.4% (82/610) in non-PPI users (p < 0.001). In multivariate analysis, PPI use without statins was not associated with increased mortality OR = 1.10 (0.76 to 1.60), while statin use without PPI was associated significant lower mortality OR = 0.28 (0.13 to 0.59). This benefit was eliminated when statins and PPI were used together (OR = 0.86;95% CI of 0.53 to 1.39). Variables associated with increased mortality risk in the logistic regression model are each decade of age (OR = 1.16;95% CI of 1.08 to 1.25), congestive heart failure OR = 2.09 (1.48 to 2.95), cancer (OR = 1.69;95% CI of 1.23 to 2.34), cardiovascular disease (OR = 2.18;95% CI of 1.27 to 3.75), and stroke (OR = 1.48;95% CI of 1.01 to 2.16). Conclusions: Statin use was associated with reduced mortality in patients with CAP, but the benefit was no longer present when combined with PPIs. The etiology for the increased mortality warrants further investigation.