Intensive statin therapy and in-hospital mortality in critically ill patients with acute ischemic stroke: A multicenter matched nested case-control study
Shaojie Jiang, Yifei Sun, Zhengli Di, Yi Jia, Hui Lei, Saibing Liu, Xiaogang Kang, Wen Jiang, Xuan Wang, Fang YangBackground
The short-term efficacy and safety of intensive statin therapy in critically ill patients with acute ischemic stroke (AIS) remain unclear.
Objectives
To evaluate the association between intensive statin therapy and in-hospital mortality in critically ill patients with AIS, and to characterize the timing of statin initiation.
Design
A matched nested case-control study within a retrospective, multicenter cohort.
Methods
We used clinical data from three neurocritical care units between January 2019 and December 2024. In-hospital deaths (cases) were matched to survivors (controls) at a ratio of up to 1:3 using nearest-neighbor propensity score matching, with prespecified calipers of ±5 years for age, ±5 points for initial National Institutes of Health Stroke Scale score, and ±365 days for admission date. Conditional logistic regression stratified by matched sets was used to estimate the association, with sequential adjustment for potential confounders.
Results
A total of 169 matched strata were established, comprising 169 cases and 455 controls. In the matched cohort, the median time from admission to the first statin dose was 10.8 hours (interquartile range 5.4-25.5), and 93.9% of treated patients received their first dose within 48 hours. In the primary analysis, intensive statin therapy was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.52; 95% confidence interval [CI] 0.31-0.87;
Conclusion
Intensive statin therapy was associated with lower in-hospital mortality in critically ill patients with AIS, without an apparent increase in severe hemorrhagic transformation. These findings support the need for prospective studies to confirm the observed associations and to define the optimal timing of statin therapy in this population.