Evaluation of the Impact of Statin Therapy Intensity on the Risk of Delirium in Critically Ill Patients Admitted to ICUs: A Multicenter Cohort Study

Abstract

Background

Statins have well-established pleiotropic effects by interrupting delirium pathogenesis through their anti-inflammatory, immunomodulatory, and antithrombotic properties. The literature presents conflicting findings regarding the effects of statins on critically ill patients. It remains unclear whether the pleiotropic properties of statins and their influence on delirium are influenced by their lipophilicity, agent-specific, or statin intensity. This study aims to evaluate the impact of statin intensity on the risk of delirium in critically ill patients.

Method

This is a multicenter, retrospective cohort study that included adult patients aged 18 years and older who received statin therapy and were admitted to the intensive care units (ICUs). Patients were categorized into high-intensity versus low-moderate intensity groups. The primary endpoint was the occurrence of delirium. The secondary endpoints were delirium recurrence during the same ICU admission, delirium-free days (DFDs) within 60 days, mortality, hospital and ICU length of stay. A propensity score (PS) matching procedure (SAS, Cary, NC) was used at a 1:1 ratio. Multivariable logistic regression was used to determine the adjusted p-value and odds ratio for outcomes.

Results

After PS matching, a total of 1054 patients were included, 527 patients in each statin group. The odds of delirium and delirium recurrence were not significantly different between the two groups (OR: 1.10, 95% CI: 0.77, 1.57, P = 0.59 and OR: 0.92, 95% CI: 0.44,1.94, P = 0.84, respectively). Moreover, there was no statistically significant difference between the two groups in terms of delirium-free days (DFDs), mortality, and ICU length of stay. In contrast, patients who received the high-intensity statin had a significantly shorter duration of hospital length of stay than the low-intermediate group (beta coefficient: −0.12, 95% CI: (−0.23, −0.01), P = 0.04).

Conclusion

The use of high-intensity statins in critically ill patients admitted to ICUs was not associated with a lower risk of delirium compared to low-moderate intensity statins. Further studies are required to confirm and explore various hypotheses and deepen the understanding of this correlation.

Keywords

statin statin intensity delirium delirium recurrence critically ill intensive care unit mortality

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