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  • Statin and mortality in COVID-19: a systematic review and meta-analysis of pooled adjusted effect estimates from propensity-matched cohorts

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Original research
Statin and mortality in COVID-19: a systematic review and meta-analysis of pooled adjusted effect estimates from propensity-matched cohorts
  1. Ahmad Fariz Malvi Zamzam Zein1,2,
  2. Catur Setiya Sulistiyana3,
  3. Uswatun Khasanah4,
  4. Arief Wibowo5,
  5. Michael Anthonius Lim6,
  6. Raymond Pranata7
  1. 1 Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Jawa Barat, Indonesia
  2. 2 Department of Internal Medicine, Waled General Hospital, Cirebon, Jawa Barat, Indonesia
  3. 3 Department of Medical Education, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Jawa Barat, Indonesia
  4. 4 Department of Biostatistics and Epidemiology, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Jawa Barat, Indonesia
  5. 5 Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
  6. 6 Universitas Pelita Harapan Fakultas Kedokteran, Tangerang, Banten, Indonesia
  7. 7 Medicine, Universitas Pelita Harapan Fakultas Kedokteran, Tangerang, Indonesia
  1. Correspondence to Dr Ahmad Fariz Malvi Zamzam Zein, Universitas Swadaya Gunung Jati, Cirebon 45132, Indonesia; fariz_zein_dr{at}yahoo.com

Abstract

Purpose Statin potentially improved outcome in patients with COVID-19. Patients who receive statin generally have a higher proportion of comorbidities than those who did not, which may introduce bias. In this meta-analysis, we aimed to investigate the association between statin use and mortality in patients with COVID-19 by pooling the adjusted effect estimates from propensity-score matching (PSM) matched studies or randomised controlled trials to reduce bias.

Methods A systematic literature search using the PubMed, Scopus and Embase databases were performed up until 1 March 2021. Studies that were designed the study to assess statin and mortality using PSM with the addition of Inverse Probability Treatment Weighting or multivariable regression analysis on top of PSM-matched cohorts were included. The effect estimate was reported in term of relative risk (RR).

Results 14 446 patients were included in the eight PSM-matched studies. Statin was associated with decreased mortality in patients with COVID-19 (RR 0.72 (0.55, 0.95), p=0.018; I2: 84.3%, p<0.001). Subgroup analysis in patients receiving statin in-hospital showed that it was associated with lower mortality (RR 0.71 (0.54, 0.94), p=0.030; I2: 64.1%, p<0.025). The association of statin and mortality was not significantly affected by age (coefficient: −0.04, p=0.382), male gender (RR 0.96 (0.95, 1.02), p=0.456), diabetes (RR 1.02 (0.99, 1.04), p=0.271) and hypertension (RR 1.01 (0.97, 1.04), p=0.732) in this pooled analysis.

Conclusion In this meta-analysis of PSM-matched cohorts with adjusted analysis, statin was shown to decrease the risk of mortality in patients with COVID-19.

PROSPERO registration number CRD42021240137.

  • cardiology
  • clinical pharmacology
  • COVID-19

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

http://dx.doi.org/10.1136/postgradmedj-2021-140409

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request.

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    Footnotes

    • Twitter @RaymondPranata

    • Contributors AFMZZ, CSS and RP were involved in the conceptualisation and design of the manuscript. AFMZZ, CSS, UK, AW, MAL and RP participated in data curation and investigation. RP performed data analysis, formal analysis, and statistical analysis. AFMZZ, CSS and UK drafted the manuscript. MAL, AW and RP review and edited the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.