S2549 Statin Use Is Associated With Reduced Risk of Hepatic Decompensation and Overall Mortality in Patients With Compensated Cirrhosis: A Propensity Score-Matched Analysis of a Population-Based Cohort of 14,034 Adults

Introduction: Statin use is often avoided in cirrhosis due to hepatotoxicity concerns. However, emerging data suggests a potential clinical benefit of statins in compensated cirrhosis. The aim of this study was to assess the impact of statin therapy on risk of hepatic decompensation, hepatocellular carcinoma (HCC) and overall mortality in a large population-based cohort. Methods: Using a large, federated electronic health based (EHR) database (TriNetX), we identified patients with compensated cirrhosis using International Classification of Diseases, Tenth Revision (ICD-10) codes. Statin users were defined as individuals taking statins at any dose for at least 1 year. Statin users were propensity score-matched 1:1 using demographics, labs, BMI, alcohol use, medical comorbidities, cirrhosis etiology, beta-blocker, opioid, and benzodiazepine use. Outcomes assessed at 1 and 4 years included composite hepatic decompensation [ascites, variceal bleeding, hepatic encephalopathy (HE), hepatorenal syndrome (HRS) spontaneous bacterial peritonitis (SBP) or hepatocellular carcinoma (HCC)]. Secondary outcomes included individual decompensation outcomes and overall mortality. Results: After matching, 14,034 patients were included in each group for 1-year outcomes, and 13,853 for 4-year outcomes. Statin use was associated with significantly lower 1-year rates of composite hepatic decompensation (6.4% vs 9.8%; OR: 0.64; 95% CI: 0.58–0.70; P < 0.0001) and overall mortality (4.5% vs 8.5%; OR: 0.51; 95% CI: 0.46–0.57; P < 0.0001). At 4 years, the statin group continued to show reduced risk of composite hepatic decompensation (10.8% vs 14.8%; OR: 0.70; 95% CI: 0.65–0.75; P < 0.0001) and overall mortality (14.6% vs 20.8%; OR: 0.65; 95% CI: 0.61–0.69; P < 0.0001). Statin use was particularly associated with reduced rates of ascites and portal hypertension, though not with reduced risk of HCC. Conclusion: In a large population-based propensity score-matched cohort of patients with compensated cirrhosis, statin therapy was associated with significantly lower rates of hepatic decompensation and overall mortality at 1 and 4 years of follow-up. These data suggest potential preventative benefit of statin therapy in adults with compensated cirrhosis that should be further assessed in future randomized clinical trials.