Impact of statins on short and long term mortality in severe community acquired pneumonia in the intensive care unit

Severe community-acquired pneumonia (sCAP) carries high mortality. While co-adjuvant therapies remain limited, statins have shown potential benefits. This study simulated a randomised controlled trial (RCT) using real-world data to evaluate the effect of statins on mortality in ICU patients with sCAP. A propensity score matching (PSM) analysis was conducted using the MIMIC-IV database. Kaplan-Meier curves evaluated the impact of statin therapy on 28-, 90-, and 365-day mortality, and Cox regression was used to confirm associations. A total of 4,742 patients met inclusion criteria, including 1,273 who received statins before and/or during the sCAP episode. PSM achieved balanced baseline characteristics between groups. Statin therapy was associated with reduced mortality: average treatment effect - 4.03% (95% CI: -6.9% to -1.0%, p = 0.007) using PSM and - 3.7% (95% CI: -6.1% to -1.3%, p = 0.002) via inverse probability weighting. Kaplan-Meier analysis showed significantly improved survival for statin users (log-rank p < 0.0001). Cox regression confirmed a protective effect (hazard ratio 0.79, 95% CI: 0.72-0.87, p = 0.0001). Statin use was associated with reduced acute and long-term mortality in patients with sCAP. These findings highlight the potential role of statins as co-adjuvant therapy, supporting further investigation to optimise treatment protocols.