Introduction Long term outcomes after community-acquired pneumonia (CAP) are poor, with high rates of readmission, cardiovascular events and mortality. No intervention has previously been shown to alter the excess morbidity and mortality associated with CAP. Statins are effective in preventing cardiovascular disease, but may also have beneficial anti-inflammatory effects. We tested the hypothesis that statin users would have improved long term outcomes following CAP.
Methods Secondary analysis of the Edinburgh pneumonia database, a prospective observational study of CAP (2005–2010). All discharged patients were included. Follow-up data were obtained from a database linked to national morbidity and mortality registers. Outcomes were assessed using cox proportional hazards regression adjusting for confounding variables (age, gender, previous cardiovascular events, ACE-inhibitor/anti-platelet use, smoking status and severity of pneumonia).
Results Data from 1631 patients with complete follow-up were analysed. Readmissions occurred in 728 patients (44.6%) with 157 readmissions within 30 days of discharge. 133 patients had a further hospitalisation with CAP. The 1 year mortality rate was 12.8%.
523 patients were current statin users. There were significant differences between statin and non-statin users. Statin users were older, suffering more cardiovascular disease, stroke, diabetes, renal disease, COPD and a greater severity of pneumonia.
1 year mortality rates were similar in statin and non-statin users. After adjusting for baseline differences, statins were associated with a non-significant trend towards lower 1 year mortality HR 0.78(0.55–1.1). When adjusted for the propensity score, the difference in mortality became statistically significant HR 0.70(0.50–0.98).
In the fully adjusted analysis, statins were not significantly associated with readmissions HR 0.85(0.70–1.03) but were associated with a significantly lower risk of recurrent pneumonia HR 0.60 (0.37–0.96). There was no association with reduced cardiovascular hospitalisations HR 0.94(0.65–1.34). There were no beneficial effects seen with either antiplatelet or ACE-inhibitor use following CAP.
Conclusion Statins are associated with reduced 1 year mortality and a significantly lower rate of recurrent pneumonia. This is the first study to show that statins may improve long term outcomes in CAP, and that the associated morbidity and mortality can be modified.
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