Assessment of the Impact of Statin Use to Predict All-Cause Mortality in Patients With Critical Cerebrovascular Disease: A Retrospective Cohort Study From the MIMIC-IV Database

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-07-27 DOI:10.1111/cns.70542

Dong Tang, Zheng Huang, Shifu Li, Fenghua Chen

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Abstract

Background

The impact of statin therapy on short-term mortality among critically ill patients with hemorrhagic stroke or ischemic stroke remains uncertain. We investigated associations between statin use and ICU and hospital mortality in this patient population.

Methods

We conducted a retrospective cohort study using the MIMIC-IV database, including 6918 patients (2960 HS and 3958 IS) after applying strict exclusion criteria. Statin use was assessed by type, dose (standard vs. high), and initiation timing (pre-ICU vs. post-ICU). Survival outcomes were evaluated using Kaplan–Meier analysis and multivariable Cox regression models, landmark analyses, and Fine–Gray competing-risk models, with propensity score matching to adjust for confounding factors.

Results

Statin use significantly reduced ICU mortality at 30 days in HS (HR = 0.59, 95% CI: 0.41–0.87) and IS (HR = 0.45, 95% CI: 0.32–0.64) cohorts. Atorvastatin and simvastatin showed pronounced protective effects, independent of dose intensity. Post-ICU initiation of statins conferred greater benefit compared with pre-ICU initiation, especially in HS patients. Shorter statin treatment duration (≥ 3 days) sufficiently captured beneficial effects. Patients with hyperlipidemia demonstrated enhanced mortality benefit.

Conclusion

Statin use is associated with significantly lower short-term mortality in critically ill stroke patients, supporting tailored strategies for optimal statin initiation and duration.

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评估他汀类药物用于预测危重脑血管疾病患者全因死亡率的影响：来自MIMIC-IV数据库的回顾性队列研究

他汀类药物治疗对出血性卒中或缺血性卒中危重患者短期死亡率的影响尚不清楚。我们调查了他汀类药物使用与ICU和住院死亡率之间的关系。方法采用MIMIC-IV数据库进行回顾性队列研究，纳入6918例患者（其中HS 2960例，IS 3958例），采用严格的排除标准。他汀类药物的使用通过类型、剂量（标准vs高）和起始时间（icu前vs icu后）进行评估。使用Kaplan-Meier分析和多变量Cox回归模型、里程碑分析和Fine-Gray竞争风险模型评估生存结果，并使用倾向评分匹配来调整混杂因素。结果他汀类药物的使用显著降低了HS组和IS组30天ICU死亡率（HR = 0.59, 95% CI: 0.41-0.87）和IS组（HR = 0.45, 95% CI: 0.32-0.64）。阿托伐他汀和辛伐他汀表现出明显的保护作用，与剂量强度无关。与icu前相比，icu后开始使用他汀类药物可获得更大的益处，特别是在HS患者中。较短的他汀类药物治疗时间（≥3天）充分捕捉到有益效果。高脂血症患者表现出更高的死亡率。结论：他汀类药物的使用可显著降低危重脑卒中患者的短期死亡率，支持针对他汀类药物的最佳起始和持续时间的定制策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.