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Population-Based Cohort Study of 29 900 Patients

Reimar W. Thomsen, MD, PhD; Anders Riis, MSc; Jette B. Kornum, MD; Steffen Christensen, MD; Søren P. Johnsen, MD, PhD; Henrik T. Sørensen, MD, DMSc

Arch Intern Med. 2008;168(19):2081-2087.

Background  While some experimental and clinical research suggests that statins improve outcomes after severe infections, the evidence for pneumonia is conflicting. We examined whether preadmission statin use decreased risk of death, bacteremia, and pulmonary complications after pneumonia.

Methods  We conducted a population-based cohort study of 29 900 adults hospitalized with pneumonia for the first time between January 1, 1997, and December 31, 2004 in northern Denmark. Data on statin and other medication use, comorbidities, socioeconomic markers, laboratory findings, bacteremia, pulmonary complications, and death were obtained from medical databases. We used regression analyses to compute adjusted mortality rate ratios within 90 days and relative risks of bacteremia and pulmonary complications after hospitalization in both statin users and nonusers.

Results  Of patients with pneumonia, 1371 (4.6%) were current statin users. Mortality among statin users was lower than among nonusers: 10.3% vs 15.7% after 30 days and 16.8% vs 22.4% after 90 days, corresponding to adjusted 30- and 90-day mortality rate ratios of 0.69 (95% confidence interval, 0.58-0.82) and 0.75 (0.65-0.86). Decreased mortality associated with statin use remained robust in various subanalyses and in a supplementary analysis using propensity score matching. In contrast, former use of statins and current use of other prophylactic cardiovascular drugs were not associated with decreased mortality from pneumonia. In statin users, adjusted relative risk for bacteremia was 1.07 (95% confidence interval, 0.69-1.67) and for pulmonary complications was 0.69 (0.42-1.14).

Conclusion  The use of statins is associated with decreased mortality after hospitalization with pneumonia.

Author Affiliations: Departments of Clinical Epidemiology (Drs Thomsen, Kornum, Christensen, Johnsen, and Sørensen and Mr Riis) and Clinical Microbiology (Dr Thomsen) and Center of Cardiovascular Research (Dr Johnsen), Aarhus University and Aalborg Hospital, Aalborg, Denmark; and Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts(Dr Sørensen).

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