Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

Boxiang Tu; Yuanjun Tang; Yi Cheng; Yuanyuan Yang; Cheng Wu; Xiaobin Liu; Di Qian; Zhansai Zhang; Yanfang Zhao; Yingyi Qin; Jia He

doi:10.3389/fmed.2021.810651

Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

Front Med (Lausanne). 2021 Dec 24:8:810651. doi: 10.3389/fmed.2021.810651. eCollection 2021.

Authors

Boxiang Tu¹, Yuanjun Tang², Yi Cheng¹, Yuanyuan Yang³, Cheng Wu¹, Xiaobin Liu⁴, Di Qian¹, Zhansai Zhang⁵, Yanfang Zhao¹, Yingyi Qin¹, Jia He¹

Affiliations

¹ Department of Military Health Statistics, Naval Medical University, Shanghai, China.
² Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ Big Data Research Office, Naval Healthcare Information Center, Faculty of Military Health Service, Naval Medical University, Shanghai, China.
⁴ Burn Institute of PLA, Department of Burns, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
⁵ Department of Occupational Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Abstract

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI). Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages. Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p < 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p < 0.001] and ICU LOS [mean difference -0.51(-0.79, -0.24); p < 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1. Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

Keywords: 30-day ICU mortality; MIMIC-IV; acute kidney injury; propensity score; statin.