Introduction
The COVID-19 pandemic is still growing around the world and more than 90
million cases around the world with over 2 million deaths, have been
identified1. Immune dysregulation and cytokine release
associated with SARS-Cov-2 infection are considered as an important
cause of mortality in this population and it could induce
hyperinflammatory state, vasculitis, and cardiovascular events2-4.
In previous studies, the anti-inflammatory role of statins in the
reduction of cytokines, in some conditions other than infectious
diseases, has been confirmed5,6. Also, studies have
been shown that patients who have received atorvastatin, had a better
prognosis in viral and bacterial pneumonia 7,8. In
some studies, it is hypothesized that decreasing the synthesis of
cholesterol by statins and depletion of cell membrane cholesterol
content, could disturb the entry of the virus into the
cells9. SARS-COV-2 also generates multi
pro-inflammatory cytokines by activating Toll-like receptors (TLRs) on T
lymphocytes 10. This TLR-MYD88-NFκB pathway promotes
cytokine release. Statins also block this pathway; inhibit T cell
activation and proliferation, so they have immunomodulatory effects11.By considering the effect of underlying conditions
such as hypertension, diabetes, cardiovascular diseases, and
hyperinflammation associated with COVID-19, statins could affect the
prognosis of the patients who have been hospitalized due to COVID-1912-14. Therefore, we aimed to assess the effect of
atorvastatin use, in the outcomes of the patients with severe to
critical COVID-19.