title: Statin use and infections in Veterans with cirrhosis.
abstract: BACKGROUND
  Evidence about the beneficial effects of statins on reducing infections is accumulating. Identifying ways to reduce infection risk in patients with cirrhosis is important because of increased mortality risk and costs associated with infections.
  
  
  OBJECTIVE
  To estimate the extent to which statin use prolongs time to infection among patients with cirrhosis.
  
  
  METHODS
  We identified Veterans with cirrhosis, but without decompensation (n = 19 379) using US Veterans Health Administration data from 2001 to 2009. New users of statins were identified and propensity matched to non-users and users of other cholesterol-lowering medications (1:1 matching). The cohort was followed up for hospitalisations with infections. Cox regression models with time-varying exposures provided estimates of adjusted hazard ratios (HR) and 95% confidence intervals (CI).
  
  
  RESULTS
  New statin use was present among 13% of VA patients with cirrhosis without decompensation. Overall, 12.4% of patients developed a serious infection, and 0.1% of patients died. In the propensity-matched sample, statin users experienced hospitalisations with infections at a rate 0.67 less than non-users (95% Confidence Interval: 0.47-0.95).
  
  
  CONCLUSIONS
  Infections are a major concern among cirrhotic patients and have the potential to seriously impact both life expectancy and quality of life. Statin use may potentially reduce the risk of infections among patients with cirrhosis.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Motzkus-Feagans
authors.forename: A L
authors.initials: AL
authors.lastname: Pakyz
authors.forename: S M
authors.initials: SM
authors.lastname: Ratliff
authors.forename: J S
authors.initials: JS
authors.lastname: Bajaj
authors.forename: K L
authors.initials: KL
authors.lastname: Lapane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D008889:Military Personnel; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000890:Anti-Infective Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008795:Metronidazole