P2428 - Hepatic Decompensation & High-Intensity Statin Therapy Are Associated with Statin-Induced Rhabdomyolysis in Patients With Cirrhosis

George Chen, MD, Meagan Alvarado, MD, Elizabeth Cohen, PharmD, Kara Ventura, ARNP, Uyen To, MD
Yale University School of Medicine, New Haven, CT

Introduction: Statins reduce liver fibrosis, portal pressure, and risk of liver decompensation in patients with advanced chronic liver disease. However, the safety profile of statins in cirrhosis is not well studied. Although statin-induced rhabdomyolysis (SIR) events in cirrhosis have been documented in case reports, their incidence and associated risk factors are unknown. As such, we conducted a retrospective cohort study of SIR and its demographic and clinical risk factors in patients with cirrhosis in a large United States healthcare system.

Methods: We included patients diagnosed with cirrhosis in the Yale New Haven Health System (YNHHS) in Connecticut, USA from January 2012 to March 2023. The YNHHS electronic health record (EHR) was queried using Slicer Dicer, a data extraction tool in the Epic EHR system, to identify participants with cirrhosis who were prescribed statins and subsequently developed rhabdomyolysis. Patient charts were manually reviewed to confirm SIR events. Demographic and clinical data, including age, sex, race, ethnicity, etiology of cirrhosis, Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, statin type and intensity, and hospitalization status were abstracted from patient charts. Associations of demographic and clinical variables with SIR were analyzed by Chi-square tests using p< 0.05.

Results: Our study comprised 20,251 patients diagnosed with cirrhosis, 8,239 (41%) of whom were prescribed statins. A total of 15 participants developed SIR, with a cumulative incidence of 0.2%. Demographic and clinical characteristics are provided in Table 1. The mean age of onset was 60 years, with the majority of patients being male (87%) and white (60%). Participants had a mean MELD score of 19.5 and Child-Pugh score of 8.4. Male sex, decompensated cirrhosis, and high-intensity statin therapy were significantly associated with SIR (p=0.005, 0.005, and 0.0002, respectively). A significantly higher proportion of SIR events occurred in the outpatient setting (80%) compared to inpatient (p=0.02).

Discussion: To our knowledge, this is the largest study of SIR in cirrhosis. The estimated cumulative incidence of SIR in patients with cirrhosis is 20-fold higher compared to that of the general population. The adverse effects of statin therapy should be carefully considered, particularly in the context of prescribing high-intensity statins in patients with decompensated cirrhosis. Future studies assessing clinical and epidemiological risk factors for SIR in cirrhosis are needed.


Disclosures:


George Chen, MD, Meagan Alvarado, MD, Elizabeth Cohen, PharmD, Kara Ventura, ARNP, Uyen To, MD. P2428 - Hepatic Decompensation & High-Intensity Statin Therapy Are Associated with Statin-Induced Rhabdomyolysis in Patients With Cirrhosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.