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.