A Retrospective Cohort Study Assessing the Impact of Statin Therapy on Hospital Length of Stay and Inpatient Mortality in COVID-19 Patients.

Abstract

Background: Coronaviruses, known for their crown-like appearance, cause mild gastrointestinal and respiratory diseases. Some cause outbreaks of respiratory diseases, most recently, SARS-CoV-2, the coronavirus disease 2019 (COVID-19). Individuals with COVID-19 are reported to be in both arterial and venous prothrombotic states. In addition to a lipid-lowering effect, statin also has an anti-inflammatory effect, which addresses one of the underlying causes of thrombosis. An in-silico study revealed that statins could directly interact with the main protease enzyme of SARS-CoV-2 and prevent infectivity. Due to these pleiotropic properties, statins may positively impact the outcome of hospitalized patients with COVID-19 infections.

Methods: A total of 26 445 acute COVID-19-infected patients were included in this study. Patients were stratified based on home statin use status: no statins, high-intensity statins (atorvastatin 40-80 mg daily and rosuvastatin 20-40 mg daily), and low-to-moderate intensity statins (all other statins). A multivariate generalized linear model and logistic regression were used to predict the hospital length of stay and inpatient mortality, respectively.

Results: The hospital length of stay was compared between low-intensity and high-intensity statin use against no statin therapy. The length of stay was 3.88 days (95% CI, 3.56-4.20; P < .0001) longer among patients with low-dose statin therapy compared to patients without. The length of stay was 4.77 days (95% CI, 4.42-5.13; P <.0001) longer among patients with high-intensity statin therapy than those without. The odds of in-hospital mortality decreased by 24% (OR, 0.76; 95% CI, 0.76-0.97) among those with high-dose statin therapy compared to patients without (P = .02). There was no statistical significance between the low-dose statin group and the no statin group for inpatient mortality.

Conclusion: Hospitalized COVID-19 patients on statin therapy, regardless of intensity, are more likely to have a longer length of stay. There may be a mortality benefit in using high-intensity statin in acute COVID-19-infected patients. The results of this study are insufficient to recommend statin therapy for inpatient COVID-19 treatment. However, patients with significant cardiovascular comorbidities, where statins are indicated, should be on these medications, especially amidst the COVID-19 pandemic. Randomized controlled trials are needed to assess the potential in-hospital benefit of statin therapy on COVID-19 patients.