The effect of statins on mortality among patients with infection: umbrella review of meta-analyses
journal contributionposted on 2023-07-26, 15:18 authored by Ramy A. Ghayda, C. H. Han, Keum Hwa Lee, Jae Seok Kim, S. E. Kim, Andreas Kronbichler, Kalthoum Tizaoui, Han Li, Ai Koyanagi, Louis Jacob, Min Seo Kim, Dong Keon Yon, Seung Won Lee, Karel Kostev, Jae Il Shin, Jae Won Yang, Lee Smith
Objective: Although previous research has reported beneficial effects of statins on infectious diseases, these have yet to be concluded. Therefore, we conducted an umbrella review to provide a comprehensive understanding of the strength of evidence and validity of claimed associations between statins (hydroxymethyl glutaryl-CoA reductase inhibitors) and infectious diseases. Patients and methods: We conducted an umbrella review and re-analyzed data from meta-analyses of randomized controlled trials and observational studies on associations between statin use and different infectious diseases such as bacteremia/sepsis and pneumonia. We also evaluated the level of evidence for each re-analyzed outcome based on the criteria using p-values of random and fixed-effects, 95% prediction intervals, small-study effects, between-study heterogeneity, and concordance between the effect estimate of the largest study and summary estimates of the meta-analysis. Moreover, publication bias was also examined. Results: Through a systematic literature search, we obtained 14 eligible articles including 25 meta-analyses. All 4 meta-analyses on overall infection, 3 out of 14 meta-analyses on bacteremia/sepsis, and 5 out of 7 meta-analyses on pneumonia demonstrated that statin use was associated with reduced mortality due to infections (caused by infections). Nonetheless, most significant results only showed a weak level of evidence, and one study with convincing evidence prior to adjustment also showed weak evidence after adjustment. Conclusions: The present review identified a protective effect of statins on infection-related mortality, but all available studies had a weak level of evidence. Therefore, further studies with a strong level of evidence are needed, and it is also necessary to investigate the types of statins and to study clinical outcomes other than mortality to gain further insights.
Publication titleEuropean Review for Medical and Pharmacological Sciences
- Published version