Date Published: April 24, 2019
Publisher: Public Library of Science
Author(s): Tsung-Hsing Hung, Chih-Chun Tsai, Hsing-Feng Lee, Saeid Ghavami.
Recent studies have shown benefits of statins in patients with liver cirrhosis. However, it is still unknown if statins have a beneficial effect on the mortality of cirrhotic patients with bacterial infections.
The Taiwan National Health Insurance Database was searched, and 816 cirrhotic patients receiving statins with bacterial infections hospitalized between January 1, 2010 and December 31, 2013 were included in the study. A one-to-four propensity score matching was performed to select a comparison group based on age, sex, and comorbid disorders.
The overall 30-day mortalities in statin and non-statin group were 5.3% and 9.8%, respectively (P = 0.001). After Cox regression modeling adjusting for age, sex, and comorbid disorders, the hazard ratio (HR) of statin use on 30-day mortality was 0.52 (95% confidence interval [CI]: 0.38–0.72, P<0.001). In subgroup analysis, the 30-day mortality effect of statin use was more pronounced in patients with pneumonia (HR = 0.34; 95% CI: 0.19–0.59; P<0.001) and bacteremia (HR = 0.55; 95% CI: 0.35–0.85; P = 0.008). Atovastatin (HR = 0.59; 95% CI: 0.37–0.93) and rosuvastatin (HR = 0.59; 95% CI: 0.36–0.98) were associated with a decreased 30-day mortality risk compared to patients not taking statins. Statin use decreases the 30-day mortality of cirrhotic patients with bacteremia and pneumonia.
Bacterial infections are the major cause of hospitalization for patients with liver cirrhosis . The mortality of patients with cirrhosis and bacterial infections is increased about four-fold during hospitalization . In addition, bacterial infections can trigger or aggravate cirrhosis-related complications such as hepatic encephalopathy, ascites, or variceal bleeding [1–6], all of which may further increase the mortality of cirrhotic patients.
After review of the database and application of the inclusion and exclusion criteria 816 patients with cirrhosis with bacterial infections receiving statins (statin group) were included in the study. After 1:4 propensity score matching, 3,264 cirrhotic patients with infections who were no receiving statins were included as the non-statin group. Table 1 shows the demographic characteristics of the statin and non-statin groups. The overall 30-day mortalities for the statin group and non-statin group were 5.3% and 9.8%, respectively (P<0.001). After Cox regression modeling adjusting for age, sex, and other comorbid disorders, the HR for 30-day mortality of the statin group was 0.52 (95% CI, 0.38–072, P<0.001) as compared to the non-statin group. Other statistically significant prognostic factors are summarized in Table 2. Age, etiology of liver cirrhosis, liver reserve, RFI, and steroid and statin usage were associated with significant differences in 30-day overall mortality. Statins are usually for the treatment of dyslipidemia, and are now also used for the prevention or treatment of various cardiovascular diseases. However, other possible benefits of statins have been the topic of current research. Although there is the potential of hepatotoxicity in statin users with chronic liver disease, the toxicity is usually mild and well tolerated. The safety of satins in patients with chronic liver disease has been shown in a prior study . A number of current studies have shown beneficial effects of statins in cirrhotic patients [7–13]. However, the effect of statins in patients with cirrhosis and bacterial infections is unclear [14–16]. Statins have been shown to have anti-inflammatory effects, and are associated with reducing or preventing the risk of liver fibrosis progression in patients with chronic liver disease . Statins have also been shown to decrease the hepatic venous pressure gradient and improve liver perfusion in patients with cirrhosis . A prior study found that patients with cirrhosis taking statins experienced hospitalizations with infections at a rate 0.67 less than that of non-users.  However, the effect of statins on mortality of cirrhotic patients with bacterial infections is not clear. Source: http://doi.org/10.1371/journal.pone.0215839