Frontiers in Medicine · Oct 31, 2026
Statin Administration During the First 24 Hours and Mortality in Critically Ill Adults With Acute Respiratory Failure: A Landmark Cohort Study Using MIMIC-IV 3.1
By hao jiaozhen, Li Minghui
Background: Whether statins administered in routine care during the first ICU day are associated with outcomes in acute respiratory failure (ARF) is uncertain. Methods: We studied adults with coded ARF in MIMIC-IV 3.1 who remained alive and in the ICU at 24 hours and had medication-administration coverage. Exposure was at least one statin administration before the 24-hour landmark. Follow-up began at that landmark. Overlap weighting and patient-clustered, covariate-adjusted Cox regression estimated the association with 30-day mortality; longer horizons and design-focused sensitivity analyses were secondary or exploratory. Results: Among 9,661 admissions from 9,062 patients, 2,573 received a statin and 2,846 died within 30 days. The adjusted overlap-weighted hazard ratio (HR) was 0.834 (95% CI 0.757–0.920; P=2.72×10⁻⁴; FDR-adjusted P=6.11×10⁻⁴). Descriptive weighted 30-day mortality was 26.1% versus 30.0%. The 90-day HR was 0.850 (95% CI 0.780–0.926). The respiratory-support/hypoxemia-enriched analysis did not meet the FDR threshold (HR 0.890; 95% CI 0.793–0.999; FDR-adjusted P=0.0527). Conclusions: Early statin administration was associated with lower subsequent mortality in this landmark cohort. Residual confounding, selection at the landmark, and inability to distinguish treatment continuation from initiation preclude a causal treatment recommendation.