title: Preinjury statin use is associated with a higher risk of multiple organ failure after injury: a propensity score adjusted analysis.
abstract: BACKGROUND
  Recent studies suggest that statin use may improve outcome in critically ill patients. This has been attributed to the pleiomorphic effect and modulation of inflammatory mediators that occurs with statin use. We sought to determine whether preinjury statin (PIS) use was associated with improved outcome in severely injured blunt trauma patients.
  
  
  METHODS
  Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt injured adults with hemorrhagic shock. Patients aged 55 years and older were analyzed. Those with isolated traumatic brain injury, cervical cord injury, and those who survived <24 hours were excluded. A propensity score predicting statin use was created using logistic regression. Cox proportional hazard regression was then used to evaluate the effects of PIS use on mortality and the development of multiple organ failure (MOF, multiple organ dysfunction syndrome >5) and nosocomial infection (NI) after adjusting for important injury characteristics and the propensity of taking PISs.
  
  
  RESULTS
  Overall mortality and MOF rates for the study cohort (n = 295) were 21% and 50%, respectively. Over 24% of patients (n = 71) reported PIS use. Kaplan-Meier analysis revealed no difference in NI or mortality over time but did show a significant higher incidence of MOF in those with PIS use (p = 0.04). Regression analysis verified PIS was independently associated with an 80% higher risk of MOF (hazard ratio: 1.8; 95% confidence interval, 1.1-2.9) and was found to be one of the strongest independent risk factors for the development of MOF.
  
  
  CONCLUSIONS
  PIS use was independently associated with a higher risk of MOF postinjury. These results are contrary to previous analyses. The protective effect of statins may be lost in the severely injured, and modulation of the inflammatory response may result in higher morbidity. Further studies are required to better understand the impact and potential therapeutic utility of this commonly prescribed medication both before and after injury.
authors.affiliation: Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Neal
authors.forename: Joseph
authors.initials: J
authors.lastname: Cushieri
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology*; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000401:mortality; D016019:Survival Analysis; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors