The effect of statins on influenza-like illness morbidity and mortality
The effect of statins on influenza-like illness morbidity and mortality
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DOI：
10.1002/pds.4112
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Suissa, Samy
中科院分区：
文献类型：
--
作者：
Brassard, Paul;Wu, Jennifer W.;Suissa, Samy
目的他汀类药物对细胞因子介导的炎症反应的影响可能影响流感的预后。我们评估了他汀类药物的使用是否降低了流感相关不良结局的发生率。此外，我们使用了新的用户研究设计，以最大限度地减少健康的用户偏见。我们通过使用不相关的结果进一步检验了非因果关系的可能性。方法我们使用英国临床实践研究数据链来识别1997-2010年间所有30岁或30岁以上的被诊断为流感样疾病的患者。使用他汀类药物的患者与未接受他汀类药物治疗的倾向得分匹配的患者进行了比较。结果是因流感或肺炎住院或在流感诊断后30天内死亡。Logistic回归估计累积发病率。结果研究队列包括5181名服用他汀类药物的患者和5181名非服用他汀类药物的患者。使用他汀类药物的患者30天住院或死亡的发生率为3.5%，未使用他汀类药物的患者为5.2%，因此使用他汀类药物的患者的30天住院或死亡发生率降低了27%(累积发生率比：0.73，95%CI：0.59~0.89)。新的他汀类药物使用者对我们的综合结果保护较少。在患有呼吸系统和心脏病的患者中，他汀类药物的作用不那么明显。他汀类药物的使用与机动车事故和烧伤的风险降低无统计学意义。结论新用户设计中他汀类药物效果的减弱，来自效果修改评估的支持证据，以及评估他汀类药物对非相关结果的影响的其他子分析表明，他汀类药物对流感相关不良后果的有益效果可能由健康的用户偏向来解释。版权所有(C)2016 John Wiley&Sons，Ltd.
Purpose The effect of statins on cytokine-mediated inflammatory responses may impact on the prognosis of influenza. We assessed whether statin use decreases the incidence of adverse influenza-related outcomes. Additionally, we used a new-user study design to minimize healthy user bias. We further examined the possibility of non-causal associations by using unrelated outcomes.Methods We used the UK Clinical Practice Research Datalink to identify all patients aged 30 or older diagnosed with influenza-like illness during 1997-2010. Statin users were compared with propensity score-matched patients not receiving statins. The outcome was hospitalization for influenza or pneumonia or death in the 30 days following influenza diagnosis. Logistic regression estimated cumulative incidence ratios.Results The study cohort included 5181 statin users matched to 5181 non-users. The 30-day incidence of hospitalization or death was 3.5% in statin users and 5.2% in non-users, resulting in a 27% lower incidence with statin use (cumulative incidence ratio: 0.73, 95% CI: 0.59-0.89). New statin users were less protected against our composite outcome. The effect of statins was less pronounced among those with respiratory and cardiac disease. Statin use was shown to be associated with a non-statistically significant risk reduction of motor vehicle accident and burns.Conclusion The attenuation of the effect of statins with the new-user design, supporting evidence from the assessment of effect modification, and additional sub-analyses evaluating the effect of statins on non-related outcomes suggest that the beneficial effect of statins on influenza-related adverse outcomes may be explained by a healthy user bias. Copyright (C) 2016 John Wiley & Sons, Ltd.