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Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury.
J Surg Res 2019; 245:367-372JS

Abstract

BACKGROUND

Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients.

METHODS

We performed a 4-y (2014-2017) review of our TBI database and included all patients aged ≥18 y with severe isolated TBI. Patients were stratified into those who were on statins and those who were not and were matched (1:2 ratio) using propensity score matching. The primary outcome was in-hospital mortality. The secondary outcomes were skilled nursing facility disposition, Glasgow Outcome Scale-extended score, and hospital and intensive care unit length of stay (LOS).

RESULTS

We identified 1359 patients, of which 270 were matched (statin: 90, no-statin: 180). Mean age was 55 ± 8y, median Glasgow Coma Scale was 10 (8-12), and median head-abbreviated injury scale was 3 (3-5). Matched groups were similar in age, mechanism of injury, Glasgow Coma Scale, Injury Severity Score, neurosurgical intervention, type and size of intracranial hemorrhage, and preinjury anticoagulant or antiplatelet use. The overall in-hospital mortality rate was 18%. Patients who received statins had lower rates of in-hospital mortality (11% versus 21%, P = 0.01), skilled nursing facility disposition (19% versus 28%; P = 0.04), and a higher median Glasgow Outcome Scale-extended (11 [9-13] versus 9 [8-10]; P = 0.04). No differences were found between the two groups in terms of hospital LOS (6 [4-9] versus 5 [3-8]; P = 0.34) and intensive care unit LOS (3 [3-6] versus 4 [3-5]; P = 0.09).

CONCLUSIONS

Preinjury statin use in isolated traumatic brain injury patients is associated with improved outcomes. This finding warrants further investigations to evaluate the potential beneficial role of statins as a therapeutic drug in a TBI.

LEVEL OF EVIDENCE

Level III Therapeutic.

Authors+Show Affiliations

Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona. Electronic address: bjoseph@surgery.arizona.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31425877

Citation

Lokhandwala, Adil, et al. "Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury." The Journal of Surgical Research, vol. 245, 2019, pp. 367-372.
Lokhandwala A, Hanna K, Gries L, et al. Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. J Surg Res. 2019;245:367-372.
Lokhandwala, A., Hanna, K., Gries, L., Zeeshan, M., Ditillo, M., Tang, A., ... Joseph, B. (2019). Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. The Journal of Surgical Research, 245, pp. 367-372. doi:10.1016/j.jss.2019.07.081.
Lokhandwala A, et al. Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. J Surg Res. 2019 Aug 16;245:367-372. PubMed PMID: 31425877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. AU - Lokhandwala,Adil, AU - Hanna,Kamil, AU - Gries,Lynn, AU - Zeeshan,Muhammad, AU - Ditillo,Michael, AU - Tang,Andrew, AU - Hamidi,Mohammad, AU - Joseph,Bellal, Y1 - 2019/08/16/ PY - 2019/05/01/received PY - 2019/07/08/revised PY - 2019/07/19/accepted PY - 2019/8/20/pubmed PY - 2019/8/20/medline PY - 2019/8/20/entrez KW - Neuroinflammation KW - Statins KW - Traumatic brain injury SP - 367 EP - 372 JF - The Journal of surgical research JO - J. Surg. Res. VL - 245 N2 - BACKGROUND: Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients. METHODS: We performed a 4-y (2014-2017) review of our TBI database and included all patients aged ≥18 y with severe isolated TBI. Patients were stratified into those who were on statins and those who were not and were matched (1:2 ratio) using propensity score matching. The primary outcome was in-hospital mortality. The secondary outcomes were skilled nursing facility disposition, Glasgow Outcome Scale-extended score, and hospital and intensive care unit length of stay (LOS). RESULTS: We identified 1359 patients, of which 270 were matched (statin: 90, no-statin: 180). Mean age was 55 ± 8y, median Glasgow Coma Scale was 10 (8-12), and median head-abbreviated injury scale was 3 (3-5). Matched groups were similar in age, mechanism of injury, Glasgow Coma Scale, Injury Severity Score, neurosurgical intervention, type and size of intracranial hemorrhage, and preinjury anticoagulant or antiplatelet use. The overall in-hospital mortality rate was 18%. Patients who received statins had lower rates of in-hospital mortality (11% versus 21%, P = 0.01), skilled nursing facility disposition (19% versus 28%; P = 0.04), and a higher median Glasgow Outcome Scale-extended (11 [9-13] versus 9 [8-10]; P = 0.04). No differences were found between the two groups in terms of hospital LOS (6 [4-9] versus 5 [3-8]; P = 0.34) and intensive care unit LOS (3 [3-6] versus 4 [3-5]; P = 0.09). CONCLUSIONS: Preinjury statin use in isolated traumatic brain injury patients is associated with improved outcomes. This finding warrants further investigations to evaluate the potential beneficial role of statins as a therapeutic drug in a TBI. LEVEL OF EVIDENCE: Level III Therapeutic. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/31425877/Preinjury_Statins_Are_Associated_With_Improved_Survival_in_Patients_With_Traumatic_Brain_Injury L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(19)30575-X DB - PRIME DP - Unbound Medicine ER -