Statins for the prevention and treatment of infections: A systematic review and meta-analysis

Abstract

Background: Emerging epidemiological evidence suggests that statin use may reduce the risk of infections and infection-related complications. Our objective was to examine the association between statin use and the risk of infections and related outcomes. Methods:Wesearched several electronic databases from inception through December 2007 for randomized trials and cohort studies that examined the association between statin use and the risk or outcome of infections. Data on study characteristics, measurement of statin use, outcomes (adjusted for potential confounders), and quality assessment were extracted. Results: Sixteen cohorts were eligible and differed in representativeness, outcome assessment, and comparability of exposed (statin) and unexposed (nonstatin) groups. Nine cohorts addressed the role of statins in treating infections: bacteremia (n=3), pneumonia (n=3), sepsis (n=2), and bacterial infection (n=1). The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2=76.5%) in favor of statins. Seven cohorts addressed infection prevention in patients with vascular diseases (n=3), chronic kidney disease (n=1), diabetes (n=1), intensive care unit-acquired infections (n=1), and in general practice (n=1). The pooled effect estimate was 0.57 (95% confidence interval, 0.43-0.75; I2=82%) in favor of statin use; there was some evidence of publication bias for this analysis (Egger test; P=.07). Meta-regression did not identify potential effect modifiers that explain the between-study heterogeneity. Conclusions: Results for our meta-analysis suggest that statin use may be associated with a beneficial effect in treating and preventing different infections. Given the presence of heterogeneity and publication bias, there is a need for randomized trials to confirm the benefit of statin use in this context. ©2009 American Medical Association. All rights reserved.