Journal Club - Statin use tied to lower risk of acute on chronic liver failure in Cirrhosis patients

Statin use tied to lower risk of acute-on-chronic liver failure in cirrhosis patients Statin use is significantly associated with reduced development of high-grade acute-on- chronic liver failure (ACLF) in patients with cirrhosis, according to results from a large, retrospective, cohort study that appears in the Journal of Hepatology.    

Considering the need to identify therapies that prevent the development of chronic liver failure in cirrhosis patients, Nadim Mahmud, Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA, and colleagues aimed to evaluate the association between statin exposure and the risk of developing ACLF in a large national cohort of patients with cirrhosis.

For this purpose, the researchers performed a retrospective cohort study of patients diagnosed with cirrhosis within the Veterans Health Administration between 2008 and 2018. Based on statin exposure, patients were stratified into 3 groups -- statin naïve, existing statin users, and new statin initiators. To comprehensively address potential confounding in estimating the association between time-updated statin exposure and the first occurrence of high-grade ACLF, Cox proportional hazards regression models with inverse probability treatment weighting and marginal structural models were utilized. 

Based on the study, the researchers reported the following findings:

The cohort included 84,963 patients, of whom 26.9% were on a statin at baseline.

 A total of 8,558 (10.1%) patients with cirrhosis were hospitalized with high-grade acute- on-chronic liver failure over a median follow-up time of 51.6 months.

Time-updated statin use was associated with a significant reduction in the hazard of developing acute-on-chronic liver failure.

Increasing doses of statin were associated with a progressively reduced hazard of developing acute-on-chronic liver failure.

 Every additional 5 months of statin exposure was associated with a 9% reduced hazard of high-grade acute-on-chronic liver failure. To conclude, "the results of this study support the promising role that statins may play in future prevention of acute-on-chronic liver failure in patients with cirrhosis."