Statin use is associated with lower disease severity in COVID-19 infection

Abstract Background and Aims: We aim to study the association of hyperlipidemia and statin use with COVID-19 severity.Methods: We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤94% requiring supplemental oxygen, intensive-care unit (ICU) admission , invasive mechanical-ventilation and death. Logistic regression models were used to study the association between hyperlipidemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined , in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05.Results: One hundred fifty-six (21.8%) patients had hyperlipidemia and 97% were on statins. There were no significant associations between hyperlipidemia and clinical outcomes. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: b-0.12(-0.23,-0.01); p=0.028). There were no other significant differences in other outcomes.Conclusion: Treated hyperlipidemia was not an independent risk factor for severe COVID-19. Statin use independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

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Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

10.21203/rs.3.rs-110077/v1 ◽

2020 ◽

Author(s):

Payam Peymani ◽

Tania Dehesh ◽

Farnaz Aligolighasemabadi ◽

Mohammadamin Sadeghdoust ◽

Katarzyna Kotfis ◽

...

Keyword(s):

Lower Risk ◽

Proportional Hazards ◽

Clinical Symptoms ◽

Statistical Significance ◽

Statin Treatment ◽

Careful Consideration ◽

Cox Proportional Hazards ◽

Lipid Lowering ◽

Risk Of Death ◽

Statin Use

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort

Clinical Infectious Diseases ◽

10.1093/cid/ciab875 ◽

2021 ◽

Author(s):

Essy Mozaffari ◽

Aastha Chandak ◽

Zhiji Zhang ◽

Shuting Liang ◽

Mark Thrun ◽

...

Keyword(s):

Proportional Hazards ◽

Statistical Significance ◽

Invasive Mechanical Ventilation ◽

Supplemental Oxygen ◽

Cox Proportional Hazards ◽

Low Flow ◽

Healthcare Database ◽

Cox Proportional Hazards Models ◽

High Flow Oxygen ◽

Oxygenation Level

Abstract Background Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited. Methods We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO. Results 28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14- and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI]: 0.76[0.70−0.83]) and 28-days (0.89[0.82−0.96]). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO:0.69[0.57−0.83], LFO:0.68[0.80−0.77], IMV/ECMO:0.70[0.58−0.84]) and 28-days (NSO:0.80[0.68−0.94], LFO:0.77[0.68−0.86], IMV/ECMO:0.81[0.69−0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81[0.70−0.93]) but no statistical significance at 28-days. Conclusions RDV initiated upon hospital admission was associated with improved survival among COVID-19 patients. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.

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Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

Translational Medicine Communications ◽

10.1186/s41231-021-00082-5 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Payam Peymani ◽

Tania Dehesh ◽

Farnaz Aligolighasemabadi ◽

Mohammadamin Sadeghdoust ◽

Katarzyna Kotfis ◽

...

Keyword(s):

Lower Risk ◽

Proportional Hazards ◽

Clinical Symptoms ◽

Statistical Significance ◽

Statin Treatment ◽

Careful Consideration ◽

Cox Proportional Hazards ◽

Lipid Lowering ◽

Risk Of Death ◽

Statin Use

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93), P = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72), P = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61–2.99), P = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07–2.33), P = 0.312]. Conclusions Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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Improved COVID-19 Outcomes following Statin Therapy: An Updated Systematic Review and Meta-analysis

BioMed Research International ◽

10.1155/2021/1901772 ◽

2021 ◽

Vol 2021 ◽

pp. 1-20

Author(s):

Amir Vahedian-Azimi ◽

Seyede Momeneh Mohammadi ◽

Maciej Banach ◽

Farshad Heidari Beni ◽

Paul C. Guest ◽

...

Keyword(s):

Tracheal Intubation ◽

Statin Therapy ◽

Disease Transmission ◽

Statistical Power ◽

Meta Analysis ◽

Random Effect ◽

Statin Treatment ◽

Icu Admission ◽

All Cause Mortality ◽

Statin Use

Background. Although vaccine rollout for COVID-19 has been effective in some countries, there is still an urgent need to reduce disease transmission and severity. We recently carried out a meta-analysis and found that pre- and in-hospital use of statins may improve COVID-19 mortality outcomes. Here, we provide an updated meta-analysis in an attempt to validate these results and increase the statistical power of these potentially important findings. Methods. The meta-analysis investigated the effect of observational and randomized clinical studies on intensive care unit (ICU) admission, tracheal intubation, and death outcomes in COVID-19 cases involving statin treatment, by searching the scientific literature up to April 23, 2021. Statistical analysis and random effect modeling were performed to assess the combined effects of the updated and previous findings on the outcome measures. Findings. The updated literature search led to the identification of 23 additional studies on statin use in COVID-19 patients. Analysis of the combined studies ( n = 47 ; 3,238,508 subjects) showed no significant effect of statin treatment on ICU admission and all-cause mortality but a significant reduction in tracheal intubation ( OR = 0.73 , 95% CI: 0.54-0.99, p = 0.04 , n = 10 studies). The further analysis showed that death outcomes were significantly reduced in the patients who received statins during hospitalization ( OR = 0.54 , 95% CI: 0.50-0.58, p < 0.001 , n = 7 studies), with no such effect of statin therapy before hospital admission ( OR = 1.06 , 95% CI = 0.82 -1.37, p = 0.670 , n = 29 studies). Conclusion. Taken together, this updated meta-analysis extends and confirms the findings of our previous study, suggesting that in-hospital statin use leads to significant reduction of all-cause mortality in COVID-19 cases. Considering these results, statin therapy during hospitalization, while indicated, should be recommended.

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Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19

Journal of General Internal Medicine ◽

10.1007/s11606-020-06527-1 ◽

2021 ◽

Author(s):

Daniel Quan ◽

Lucía Luna Wong ◽

Anita Shallal ◽

Raghav Madan ◽

Abel Hamdan ◽

...

Keyword(s):

Socioeconomic Status ◽

Clinical Outcomes ◽

Smoking Status ◽

Invasive Mechanical Ventilation ◽

Neighborhood Disadvantage ◽

Living Environment ◽

Median Income ◽

Logistic Regression Models ◽

Icu Admission ◽

The Impact

Abstract Background The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19). Objective To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19. Design Retrospective cohort study. Setting Four hospitals in an integrated health system serving southeast Michigan. Participants Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction. Main Measures Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment. Key Results Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531–56,095) vs. $63,317 (49,850–85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001). Conclusions Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.

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Point-of-Care Ultrasound (POCUS) Predicts Clinical Outcomes in Patients with COVID-19.

10.1101/2021.04.13.21255445 ◽

2021 ◽

Author(s):

Andre Kumar ◽

Yingjie Weng ◽

Sally Graglia ◽

Thomas Lew ◽

Kavita Gandhi ◽

...

Keyword(s):

Clinical Outcomes ◽

Point Of Care ◽

Supplemental Oxygen ◽

Adverse Outcomes ◽

Normal Lung ◽

Point Of Care Ultrasound ◽

Icu Admission ◽

Medical Centers ◽

Emergency Department Triage ◽

B Lines

Introduction: Point-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes. Methods: We conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received cardiac or lung POCUS with a 12-zone protocol. Images were interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was ICU admission incidence. Secondary outcomes included intubation and supplemental oxygen usage. Results: N=160 patients (N=201 scans) were included. Scans were collected a median 23 hours (IQR:7-80) from emergency department triage. Triage POCUS findings associated with ICU admission included B-lines (OR 4.41 [95% CI:1.71-14.30]; p<0.01) or consolidation (OR 2.49 [95% CI:1.35-4.86]; p<0.01). B-lines were associated with intubation (OR 3.10 [95% CI:1.15-10.27]; p=0.02) and supplemental oxygen usage (OR 3.74 [95% CI:1.63-8.63; p<0.01). Consolidations present on triage were associated with the need for oxygen at discharge (OR 2.16 [95% CI: 1.01-4.70]; p=0.047). A normal lung triage scan was protective for ICU admission (OR 0.28 [95% CI:0.09-0.75; p<0.01) or need for supplemental oxygen during the hospitalization (OR 0.26 [95% CI:0.11-0.61]; p<0.01). Triage cardiac POCUS scans were not associated with any outcomes. Discussion: Lung POCUS findings detected early in the hospitalization may provide expedient risk stratification for important COVID-19 clinical outcomes, including ICU admission, intubation, or need for oxygen on discharge. A normal admission scan appears protective against adverse outcomes, which may aid in triage decisions of patients.

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Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

10.21203/rs.3.rs-106030/v1 ◽

2020 ◽

Author(s):

Payam Peymani ◽

Tania Dehesh ◽

Farnaz Aligolighasemabadi ◽

Mohammadamin Sadeghdoust ◽

Katarzyna Kotfis ◽

...

Keyword(s):

Lower Risk ◽

Proportional Hazards ◽

Clinical Symptoms ◽

Statistical Significance ◽

Statin Treatment ◽

Careful Consideration ◽

Cox Proportional Hazards ◽

Lipid Lowering ◽

Risk Of Death ◽

Statin Use

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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Impact of three consecutive intravenous doses of tocilizumab in severe COVID-19 pneumonia: a retrospective cohort study

Microbes, Infection and Chemotherapy ◽

10.54034/mic.e1251 ◽

2021 ◽

Vol 1 ◽

pp. e1251

Author(s):

Raihan Rabbani ◽

Md Jahidul Hasan ◽

Ahmad Mursel Anam ◽

Shihan Mahmud Redwanul Huq

Keyword(s):

Mortality Rate ◽

Clinical Outcomes ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Supplemental Oxygen ◽

Intravenous Dose ◽

Blood Oxygen ◽

Blood Oxygen Saturation ◽

Ventilation Support ◽

Mechanical Ventilation Support

Background. Acute respiratory distress syndrome (ARDS) in severe COVID-19 pneumonia is mostly responsible for high mortality rate. Tocilizumab, an interleukin-6 (IL-6) inhibitors, down-regulates the progression of cytokine storm leading to ARDS. Objectives. The study aimed to assess the clinical outcomes of three consecutive intravenous doses of tocilizumab in patients with severe COVID-19 pneumonia. Methods. This retrospective observational study was conducted on severe COVID-19 pneumonia patients in a single-center who were treated with three intravenous dose of tocilizumab (8 mg/Kg of body weight, max 800 mg per dose × 3) along with intravenous dexamethasone. Three doses of tocilizumab-associated changes in respiratory function, clinical outcomes and mortality rate were analyzed. Results. Seventy-four patients (N) received intravenous tocilizumab therapy. After third intravenous dose of tocilizumab (48-72 h apart from the second dose), SpO2 (blood oxygen saturation) was increased and the requirement of supplemental oxygen (RSO) was decreased more than after the second dose [Median: 96.5% (IQR: 96-98%) and Median: 0 (IQR: 0-1 L), respectively versus Median: 92% (IQR: 91-92%) and Median: 6 L (IQR: 5-7.2 L, respectively] (P <0.05). SpO2 was normalized in 78.4% of patients (P=0.001) treated with three doses of tocilizumab. Further RSO and demand of invasive mechanical ventilation support were increased in 21.6% (58/74 patients) and 14.8% (11/74 patients) of patients, respectively with a 30-day mortality rate of 4% (3/74 patients). Tocilizumab therapy was well tolerated in all patients. Conclusions. An additional third intravenous dose of tocilizumab improved clinical outcomes and reduced mortality rate in patients with severe COVID-19 pneumonia.

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Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽

10.1136/bmjopen-2020-044384 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044384

Author(s):

Guduru Gopal Rao ◽

Alexander Allen ◽

Padmasayee Papineni ◽

Liyang Wang ◽

Charlotte Anderson ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Outcomes ◽

Severe Infection ◽

Older Age ◽

Cross Sectional ◽

North West ◽

Icu Admission ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

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