# Assessment of the Impact of Statin Use to Predict All‐Cause Mortality in Patients With Critical Cerebrovascular Disease: A Retrospective Cohort Study From the MIMIC‐IV Database

## TL;DR

Statin use is linked to lower short-term mortality in critically ill stroke patients, especially when started after ICU admission and with specific statin types.

## Contribution

The study identifies post-ICU statin initiation and specific statin types as key factors in reducing mortality in critical stroke patients.

## Key findings

- Statin use significantly reduced ICU mortality at 30 days in both hemorrhagic and ischemic stroke patients.
- Post-ICU initiation of statins conferred greater mortality benefit, particularly in hemorrhagic stroke patients.
- Atorvastatin and simvastatin showed the strongest protective effects, independent of dose intensity.

## Abstract

The impact of statin therapy on short‐term mortality among critically ill patients with hemorrhagic stroke or ischemic stroke remains uncertain. We investigated associations between statin use and ICU and hospital mortality in this patient population.

We conducted a retrospective cohort study using the MIMIC‐IV database, including 6918 patients (2960 HS and 3958 IS) after applying strict exclusion criteria. Statin use was assessed by type, dose (standard vs. high), and initiation timing (pre‐ICU vs. post‐ICU). Survival outcomes were evaluated using Kaplan–Meier analysis and multivariable Cox regression models, landmark analyses, and Fine–Gray competing‐risk models, with propensity score matching to adjust for confounding factors.

Statin use significantly reduced ICU mortality at 30 days in HS (HR = 0.59, 95% CI: 0.41–0.87) and IS (HR = 0.45, 95% CI: 0.32–0.64) cohorts. Atorvastatin and simvastatin showed pronounced protective effects, independent of dose intensity. Post‐ICU initiation of statins conferred greater benefit compared with pre‐ICU initiation, especially in HS patients. Shorter statin treatment duration (≥ 3 days) sufficiently captured beneficial effects. Patients with hyperlipidemia demonstrated enhanced mortality benefit.

Statin use is associated with significantly lower short‐term mortality in critically ill stroke patients, supporting tailored strategies for optimal statin initiation and duration.

Statin use in critically ill stroke patients is associated with reduced short‐term ICU and hospital mortality, particularly with post‐ICU initiation and at least 3 days of treatment. Atorvastatin and simvastatin showed the strongest protective effects. These findings support tailored statin strategies in acute stroke care.