Thématique :
- Foie
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Nom du veilleur :
Professeur Jean-Marie PERON
Coup de coeur :
  2015 Oct. pii: S0016-5085(15)01476-6  
  doi: 10.1053/j.gastro.2015.10.007  
  Statins are Associated with a Decreased Risk of Decompensation and Death in Veterans with Hepatitis C-related Compensated Cirrhosis  
  Mohanty A, Tate J, Garcia-Tsao G  

Background & aims
Statins decrease portal pressure in patients with cirrhosis and increase survival times of those who have bled from varices. However, statins can be hepatotoxic. It is important to determine whether long-term statin use will be beneficial or detrimental for patients with cirrhosis because physicians are reluctant to prescribe statins to patients with liver disease. We investigated effects of statins on decompensation and survival times in patients with compensated cirrhosis.

We performed a retrospective cohort using the Veteran Affairs Clinical Case Registry, which contains nationwide data from veterans infected with the hepatitis C virus (HCV). We identified patients with compensated cirrhosis from January 1996 through December 2009. Statin use was according to filled prescriptions. Cirrhosis and decompensation were determined from ICD9 codes, using a validated algorithm.

Among 40,512 patients with HCV compensated cirrhosis (98% male, median age of 56 years), 2802 statin users were identified. We developed a propensity score model using variables associated with statin prescription, and new statin users were matched with up to 5 non-users; 685 statin users were matched with 2062 non-users. Discrimination of the propensity score model was 0.92. Statin users had lower risk of decompensation (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.39-0.77)] and death (HR, 0.56; 95% CI, 0.46-0.69), compared with non-users. Findings persisted after adjustment for age, FIB-4 index score, serum level of albumin, model for end-stage liver disease and Child scores (HR for decompensation, 0.55; 95% CI, 0.39-0.78) and HR for death, 0.55; 95% CI, 0.45-0.68).

Based on data from the Veteran Affairs Clinical Case Registry, statin use among patients with HCV and compensated cirrhosis is associated with over 40% lower risk of cirrhosis decompensation and death. Although statins cannot yet be widely recommended for these patients, their use should not be avoided.

Question posée
Les statines sont-elles délétères ou bénéfiques chez les patients atteints de cirrhose ?
Question posée
Elles sont bénéfiques. 40 % de décompensation et mortalité en moins.

Au minimum, les statines (réputées hépatotoxiques) ne doivent pas être CI chez le cirrhotique.