Abstract
Background
The association between statin use and sepsis-associated delirium (SAD) remains controversial. This study aimed to determine whether statin use decrease the risk of SAD.
Methods
This retrospective cohort study analyzed data of 6649 adult Intensive Care Unit (ICU) patients from the MIMIC-IV database who met inclusion criteria. We examined the association between prior to ICU admission (pre-ICU) statin use and the incidence of SAD by univariate and multivariable logistic regression analysis, propensity score matching (PSM), inverse probability weighting (IPW), and subgroup analysis employing propensity score matching and inverse probability weighting to adjust for potential confounders. The adjusted odds ratio (OR) with 95% CI were calculated in corresponding cohorts.
Results
Of the study population, 35.1% patients developed SAD. Patients with pre-ICU statin use showed a lower incidence of SAD compared to those without (27.6% vs. 38.0% in origin cohort, 27.2% vs. 33.9% in the matched cohort). Pre-ICU statin use showed a stable protective effect against SAD across different analyses: in original cohort (OR 0.562, 95% CI 0.491 ~ 0.642, P < 0.001), propensity score matched cohort (OR 0.707, 95% CI 0.630 ~ 0.794, P < 0.001) and inverse probability weighted cohort (OR 0.627, 95% CI 0.573 ~ 0.686, P < 0.001). E-value analysis suggested the robustness to unmeasured confounding.
Conclusion
Pre-ICU statin use is associated with a reduced incidence of SAD, particularly among elderly patients and those receiving lipophilic statins. These findings support the potential role of statins administration in the management of delirium in septic patients and underscore the importance of maintaining statin therapy during critical illness. Future prospective studies are needed to confirm these results and guide clinical practice.