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Research ArticleOriginal Article
Open Access

Statin use and clinical outcomes in hospitalized COVID-19 patients

A retrospective analysis in Riyadh, Saudi Arabia

Khalid S. Alshaalan, Rahaf F. Alkahtani, Renad F. Althobaiti, Rana A. Aldhahi, Fatimah Z. Rebh, Sarah S. Algezlan, Salma M. Alanazi, Shawg S. Alrumaih, Basma A. Alturki, Abdullah S. Alahmadi, Raneem A. Alanazi, Alaa H. Al Ali and Othman M. Alshabanah
Saudi Medical Journal February 2024, 45 (2) 171-178; DOI: https://doi.org/10.15537/smj.2024.45.2.20230589
Khalid S. Alshaalan
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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  • ORCID record for Khalid S. Alshaalan
  • For correspondence: [email protected]
Rahaf F. Alkahtani
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Renad F. Althobaiti
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Rana A. Aldhahi
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Fatimah Z. Rebh
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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Sarah S. Algezlan
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Salma M. Alanazi
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Shawg S. Alrumaih
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Basma A. Alturki
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Abdullah S. Alahmadi
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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Raneem A. Alanazi
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Roles: Medical student
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Alaa H. Al Ali
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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Othman M. Alshabanah
From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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Article Figures & Data

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    Figure 1

    - Symptoms prevelence at admission.

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    Figure 2

    - The prevelence of medical comorbidities presented among patients.

Tables

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    Table 1

    - The demographic factors of the patients (N=689).

    Variablesn (%)
    Nationality
    Saudi302 (43.8)
    Non-Saudi387 (56.2)
    Gender
    Male464 (67.3)
    Female225 (32.7)
    Age, mean±SD53.7±15.12
    <3040 (5.8)
    31-60422 (61.2)
    61-90224 (32.5)
    >903 (0.4)
    BMI, mean±SD29.89±6.63
    Underweight15 (2.2)
    Normal weight100 (14.5)
    Overweight251 (36.4)
    Obese323 (46.9)
    Initial location of admission
    Isolated ward577 (83.7)
    ICU101 (14.7)
    HDU11 (1.6)
    Duration of hospitalization (days)14.82±19.33
    Duration of presenting symptoms at the time of admission (days)6.09±3.52

    Values are presented as numbers and precentages (%) or mean ± standard deviation (SD). BMI: body mass index, ICU: intensive care unit, HDU: high dependency unit

      • View popup
      Table 2

      - Baseline laboratory test results in the total sample and between those received and not received statin.

      ParametersTotalReceiving statinP-values
      NoYes
      WBC (x10^9/L)7.94±4.357.91±4.448.07±4.030.683
      Hgb (g/L)38.35±89.5340.30±98.9131.66±43.790.312
      Absolute neutrophils (x10^9/L)7.12±15.717.35±17.76.33±3.810.50
      Absolute neutrophils (Low) (x10^9/L)5.00±7.635.28±8.94.25±2.050.415
      PLT (x10^9/L)228.01±88.46224.49±83.14240.16±104.210.054
      Absolute lymphocytes (x10^9/L)1.46±6.01.49±6.741.35±1.830.804
      ESR (mm/h)66.90±33.8664.34±33.4975.48±33.780.001*
      INR1.22±1.41.23±1.581.20±0.460.819
      D-dimer (ug/ml)2.06±3.852.10±4.21.92±2.310.653
      Fibrinogen level (g/L)8.57±28.089.11±32.136.83±1.610.594
      Fibrinogen level (lowest) (g/L)5.09±1.675.12±1.764.98±1.390.630
      ALP (U/L)102.73±40.1194.00±42.25126.00±26.000.259
      AST (U/L)77.87±258.977.69±282.8278.55±132.130.980
      ALT (U/L)48.49±61.78 U/L48.78±58.32 U/L47.49±72.68 U/L0.822
      GGT (U/L)129.93±132.01129.97±131.15129.82±140.810.998
      Total bilirubin (umol/day)15.17±20.6614.21±18.4518.65±27.010.023*
      Urea (mmol/L)10.81±9.539.82±8.6614.15±11.420.000*
      Creatinine (umol/day)133.42±167.59120.74±147.71176.52±217.450.000*
      CK-MB (U/L)51.88±70.8547.65±62.8466.01±91.620.008*
      CK (U/L)531.62±1136.92506.64±1053.67612.85±1374.780.350
      LDH (U/L)522.77±1398.74547.96±1589.1439.68±282.480.553
      Troponin-I (ng/mL)0.57±3.690.19±1.521.88±7.090.000*
      CRP (mg/dL)13.22±81.4314.50±91.888.54±5.460.588
      Ferritin (ng/mL)699.57±639.56733.84±668.89580.99±511.90.066
      Total cholesterol (mmol/L)4.76±16.125.04±18.854.03±2.370.556
      TGD (mmol/L)2.60±9.962.17±4.473.72±17.550.149
      HDL (mmol/L)0.83±0.570.84±0.610.80±0.430.645
      LDL (mmol/L)303.09±2707.58322.62±2672.17252.74±2806.880.805
      HbA1c (%)7.34±2.527.12±2.488.13±2.480.000*

      Values are presented as mean ± standard deviation (SD).

      WBC: white blood count, Hgb: Hemoglobin, PLT: platelet count, ESR: erythrocyte sedimentation rate, INR: International normalized ratio, ALP: alkaline phosphatase, AST: aspartate aminotransferase, ALT: alanine transaminase, GGT: gamma-glutamyl transferase, CK-MB: creatine kinase-myoglobin binding

      • ↵* Significant at a p-value of <0.05.

      • View popup
      Table 3

      - The relation between receiving statin and outcomes of patients with coronavirus disease-19.

      OutcomesReceived statinRisk associated with statinP-values
      NoYesRR (95% CI)
      Need for O2
      No118 (22.1)25 (16.1)1.47 (0.92:2.37)0.107
      Yes416 (77.9)130 (83.9)
      Admitted to ICU
      No397 (74.3)99 (63.9)1.64 (1.12: 2.39)0.011*
      Yes137 (25.7)56 (36.1)
      qSOFA score at admission to ICU
      No sepsis478 (89.5)133 (85.8)1.41 (0.83: 2.39)0.200
      Sepsis56 (10.5)22 (14.2)
      Was patient intubated?
      No441 (82.6)113 (72.9)1.76 (1.59: 2.68)0.008*
      Yes93 (17.4)42 (27.1)
      Need inotropic support?
      No481 (90.1)134 (86.5)1.42 (0.82: 2.44)0.200
      Yes53 (9.9)21 (13.5)
      Hospital complication
      None435 (81.5)99 (63.9)2.48 (1.67: 3.68)0.000*
      Yes99 (18.5)56 (36.1)
      Mortality
      No502 (94.0)129 (83.2)3.16 (1.82: 5.49)0.000*
      Yes32 (6.0)26 (16.8)

      Values are presented as numbers and precentages (%).

      O2: oxygen, ICU: intensive care unit, qSOFA: quick sequential organ failure assessment, RR: relative risk, CI: confidence interval

      • ↵* Significant at a p-value of <0.05.

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    Statin use and clinical outcomes in hospitalized COVID-19 patients
    Khalid S. Alshaalan, Rahaf F. Alkahtani, Renad F. Althobaiti, Rana A. Aldhahi, Fatimah Z. Rebh, Sarah S. Algezlan, Salma M. Alanazi, Shawg S. Alrumaih, Basma A. Alturki, Abdullah S. Alahmadi, Raneem A. Alanazi, Alaa H. Al Ali, Othman M. Alshabanah
    Saudi Medical Journal Feb 2024, 45 (2) 171-178; DOI: 10.15537/smj.2024.45.2.20230589

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    Statin use and clinical outcomes in hospitalized COVID-19 patients
    Khalid S. Alshaalan, Rahaf F. Alkahtani, Renad F. Althobaiti, Rana A. Aldhahi, Fatimah Z. Rebh, Sarah S. Algezlan, Salma M. Alanazi, Shawg S. Alrumaih, Basma A. Alturki, Abdullah S. Alahmadi, Raneem A. Alanazi, Alaa H. Al Ali, Othman M. Alshabanah
    Saudi Medical Journal Feb 2024, 45 (2) 171-178; DOI: 10.15537/smj.2024.45.2.20230589
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    Keywords

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