Statins reduce the risk of liver decompensation and death in chronic viral hepatitis: a propensity score weighted landmark analysis

Background: Decompensated liver disease due to portal hypertension leads to significant morbidity and mortality. Statins can modulate intrahepatic vascular tone, but the clinical significance remains uncertain. Aim: To determine the effects of statin use on the risk of liver decompensation and death among patients with chronic viral hepatitis. Methods: We conducted a population wide cohort study using a hospital based database from the Hong Kong Hospital Authority. Adults with chronic viral hepatitis without prior liver decompensation were identified from 2000 to 2012 by International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic codes. Statin use was defined as a cumulative defined daily dose of >28. Landmark analysis was used to overcome immortal time bias. Propensity score weighting was further performed to minimise baseline confounders. Primary outcome was a composite of portal hypertension related liver decompensation events, with adjustment for death as a competing risk. Results: A total of 69184 patients with chronic viral hepatitis (2053 statin users and 67131 statin non-users) were identified for the 2-year landmark analysis. After propensity score weighting of 23 baseline covariates, statin use was associated with a significant reduction in composite liver decompensation events (HR: 0.55; 95% CI: 0.36-0.83; P=.005), ascites (HR: 0.57; 95% CI: 0.36-0.92; P=.02), and a dose-dependent decrease in death (HR: 0.87; 95% CI: 0.76-0.99; P=.035) relative to no statin use. Conclusions: Patients with chronic viral hepatitis who used statins have a reduced risk of liver decompensation and death compared to non-users in this propensity score weighted landmark analysis.