Association Between Use of Statins and Mortality Among Patients Hospitalized With Laboratory-Confirmed Influenza Virus Infections: A Multistate Study

Oregon Public Health Division, Portland, OR 97212, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 01/2012; 205(1):13-9. DOI: 10.1093/infdis/jir695
Source: PubMed


Statins may have anti-inflammatory and immunomodulatory effects that could reduce the risk of mortality from influenza virus infections.
The Centers for Disease Control and Prevention's Emerging Infections Program conducts active surveillance for persons hospitalized with laboratory-confirmed influenza in 59 counties in 10 states. We analyzed data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between receiving statins and influenza-related death.
We identified 3043 patients hospitalized with laboratory-confirmed influenza, of whom 1013 (33.3%) received statins and 151 (5.0%) died within 30 days of their influenza test. Patients who received statins were more likely to be older, male, and white; to suffer from cardiovascular, metabolic, renal, and chronic lung disease; and to have been vaccinated against influenza that season. In a multivariable logistic regression model, administration of statins prior to or during hospitalization was associated with a protective odds of death (adjusted odds ratio, 0.59 [95% confidence interval, .38-.92]) when adjusting for age; race; cardiovascular, lung, and renal disease; influenza vaccination; and antiviral administration.
Statin use may be associated with reduced mortality in patients hospitalized with influenza.

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    • "Improvements in the pharmaceutical management of HPAI including the prompt use of antivirals and reduced prescribing of corticosteroids and antibiotics, also have potential to reduce the COI and improve outcomes. There is also growing support for various non antiviral generic drugs including statins, which may reduce mortality from severe influenza through mediation of the immune response and are widely available at low cost [31-33]. "
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    ABSTRACT: Background Southeast Asia has been identified as a potential epicentre of emerging diseases with pandemic capacity, including highly pathogenic influenza. Cambodia in particular has the potential for high rates of avoidable deaths from pandemic influenza due to large gaps in health system resources. This study seeks to better understand the course and cost-of-illness for cases of highly pathogenic avian influenza in Cambodia. Methods We studied the 18 laboratory-confirmed cases of avian influenza subtype H5N1 identified in Cambodia between January 2005 and August 2011. Medical records for all patients were reviewed to extract information on patient characteristics, travel to hospital, time to admission, diagnostic testing, treatment and disease outcomes. Further data related to costs was collected through interviews with key informants at district and provincial hospitals, the Ministry of Health and non-governmental organisations. An ingredient-based approach was used to estimate the total economic cost for each study patient. Costing was conducted from a societal perspective and included both financial and opportunity costs to the patient or carer. Sensitivity analysis was undertaken to evaluate potential change or variation in the cost-of-illness. Results Of the 18 patients studied, 11 (61%) were under the age of 18 years. The majority of patients (16, 89%) died, eight (44%) within 24 hours of hospital admission. There was an average delay of seven days between symptom onset and hospitalisation with patients travelling an average of 148 kilometres (8-476 km) to the admitting hospital. Five patients were treated with oseltamivir of whom two received the recommended dose. For the 16 patients who received all their treatment in Cambodia the average per patient cost of H5N1 influenza illness was US$300 of which 85.0% comprised direct medical provider costs, including diagnostic testing (41.2%), pharmaceuticals (28.4%), hospitalisation (10.4%), oxygen (4.4%) and outpatient consultations (0.6%). Patient or family costs were US$45 per patient (15.0%) of total economic cost. Conclusion Cases of avian influenza in Cambodia were characterised by delays in hospitalisation, deficiencies in some aspects of treatment and a high fatality rate. The costs associated with medical care, particularly diagnostic testing and pharmaceutical therapy, were major contributors to the relatively high cost-of-illness.
    BMC Public Health 06/2013; 13(1):549. DOI:10.1186/1471-2458-13-549 · 2.26 Impact Factor
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    • "As statins represent one of the most widely prescribed classes of drug in the world, identifying the capacity of statins to reduce influenza virus morbidity and mortality in the event of a pandemic or simply to extend the time between onset of illness and development of severe disease, thus allowing a greater window for the efficacy of existing antiviral treatments, is a matter of great public health importance. Despite conflicting reports, several retrospective observational studies have identified an association between statin use and reductions in influenza virus morbidity in humans; however, these studies are limited by the substantial variability in timing and duration of drug administration among participants, or the inclusion of pneumonia morbidity in the absence of laboratoryconfirmed influenza virus infection (Brett et al., 2011; Frost et al., 2007; Kwong et al., 2009; Mortensen et al., 2005; Vandermeer et al., 2012). Selected animal studies have further suggested a protective role for statins and other nonspecific antiinflammatory drug regimens against acute lung injury, but results have been mixed (Budd et al., 2007; Ferraro et al., 2011; Gower and Graham, 2001; Jacobson et al., 2005; Salomon et al., 2007; Walsh et al., 2011). "
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    ABSTRACT: Nonspecific anti-inflammatory drugs have been purported to reduce the burden of severe influenza disease. We demonstrate that, unlike oseltamivir administration, simvastatin administration did not reduce morbidity, mortality, or viral load of mice infected with H1N1 or H5N1 viruses. No added benefit to the efficacy of oseltamivir therapy was observed when mice were treated in combination with simvastatin. Modest reductions in lung cytokine production in H5N1 but not H1N1 virus-infected simvastatin-treated mice indicate a potential benefit for statin use in mitigating disease following severe virus infection.
    Virology 02/2013; 439(1). DOI:10.1016/j.virol.2013.01.017 · 3.32 Impact Factor
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    • "However, these studies have generated contradictory claims. In one retrospective study [72], a database of 3,043 adults in the US hospitalized with laboratory-confirmed influenza during the 2007 to 2008 influenza season was analyzed. Of these patients, 1,013 received statins and 151 died within 30 days of their influenza test. "
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    ABSTRACT: Influenza has a long history of causing morbidity and mortality in the human population through routine seasonal spread and global pandemics. The high mutation rate of the RNA genome of the influenza virus, combined with assortment of its multiple genomic segments, promote antigenic diversity and new subtypes, allowing the virus to evade vaccines and become resistant to antiviral drugs. There is thus a continuing need for new anti-influenza therapy using novel targets and creative strategies. In this review, we summarize prospective future therapeutic regimens based on recent molecular and genomic discoveries.
    BMC Medicine 09/2012; 10(1):104. DOI:10.1186/1741-7015-10-104 · 7.25 Impact Factor
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