The protective association between statins use and adverse outcomes among COVID-19 patients: A systematic review and meta-analysis

  1. Ronald Chow
  2. James Im
  3. Nicholas Chiu
  4. Leonard Chiu
  5. Rahul Aggarwal
  6. Jihui Lee
  7. Young-Geun Choi
  8. Elizabeth Horn Prsic
  9. Hyun Joon Shin

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Abstract

Statins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage.

Methods

Literatures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately.

Results

Thirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88).

Conclusion

Patients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

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  1. Version published to 10.1371/journal.pone.0253576
  2. ScreenIT

    SciScore for 10.1101/2021.02.08.21251070: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableFor studies included at this stage, demographics such as sample size, study design, patient population, central measures of tendency for age, percentage male, and percentage of statin users were noted.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search Strategy: Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 2019 to December 2020, for English-language publications.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study was not without limitations. Intrinsic to meta-analysis study designs, the strength of meta-analysis conclusions is limited to the strength of the input studies and underlying data. As all included studies are observational studies, randomized controlled trials are needed to confirm whether statin can be beneficial in patients with COVID-19 as COVID-19-specific treatment agent. Additionally, there is a general paucity of literature. While there are thirteen studies reporting on mortality, only two studied ICU patients. Only two studies reported on ICU admissions; only one study reported on mechanical ventilation. We need further research to address whether statin is beneficial in terms of preventing ICU admission or mechanical ventilation, which are surrogate markers of severe COVID-19 infection. In conclusion, patients administered statins after COVID-19 diagnosis were at lower risk of mortality. Ultimately, all included studies in this analysis were observational and predominantly retrospective in nature. Further prospective investigation is needed to assess whether statins may be an effective therapy in COVID-19 patients. Continued investigation is required to assess statin use among COVID-19 patients with respect to other outcomes, such as ICU admissions and mechanical ventilation.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.08.21251070v1 on medRxiv