TY - JOUR
T1 - The effect of statins on mortality among patients with infection
T2 - Umbrella review of meta-analyses
AU - Ghayda, R. A.
AU - Han, C. H.
AU - Lee, K. H.
AU - Kim, J. S.
AU - Kim, S. E.
AU - Hong, S. H.
AU - Kim, M.
AU - Kronbichler, A.
AU - Tizaoui, K.
AU - Li, H.
AU - Koyanagi, A.
AU - Jacob, L.
AU - Kim, M. S.
AU - Yon, D. K.
AU - Lee, S. W.
AU - Kostev, K.
AU - Shin, J. I.
AU - Yang, J. W.
AU - Smith, L.
N1 - Publisher Copyright:
© 2021 Verduci Editore s.r.l. All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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. MATERIALS 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.
AB - 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. MATERIALS 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.
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U2 - 10.26355/eurrev_202103_25432
DO - 10.26355/eurrev_202103_25432
M3 - Review article
C2 - 33829455
AN - SCOPUS:85103681597
VL - 25
SP - 2685
EP - 2695
JO - European Review for Medical and Pharmacological Sciences
JF - European Review for Medical and Pharmacological Sciences
SN - 1128-3602
IS - 6
ER -