title: Premorbid statin use is associated with improved survival and functional outcomes in older head-injured individuals.
abstract: OBJECTIVE
  To determine whether preinjury statin use is associated with survival and functional recovery in older adult victims of moderate/severe head trauma.
  
  
  METHODS
  Using the National Study of Costs and Outcomes of Trauma dataset compiled from 69 US hospitals, the effect of preinjury statin use was assessed for in-hospital mortality and functional outcome in patients aged ≥65 with head injury Abbreviated Injury Score (AIS)≥3. Individuals dying within 24 hours of admission or presenting with fixed dilated pupils were excluded. The Extended Glasgow Outcome Scale, dichotomized at the ability to return to premorbid major activity, was used to measure functional outcome. Multivariate regression modeled statin use and outcomes controlling for demographic, comorbidity, and injury characteristics.
  
  
  RESULTS
  Of 523 eligible individuals, 117 (22%) used statins at the time of injury. Statin use was associated with a 76% lower adjusted risk of in-hospital death (relative risk [RR]=0.24; 95% confidence interval [CI], 0.08-0.69). Of 395 individuals discharged alive, 303 survived 1 year and 264 had complete Extended Glasgow Outcome Scale scores. Statin users and nonusers demonstrated similar risk of good recovery at 3 months (RR=0.83; 95% CI, 0.46-1.49). At 12 months postinjury, statin users had 13% higher likelihood of good recovery (RR=1.13; 95% CI, 1.01-1.26). The presence of cardiovascular comorbidities abrogated this effect.
  
  
  CONCLUSIONS
  Preinjury statin use in older adult traumatic brain injury victims is associated with reduced risk of death and improved functional recovery at 12 months postinjury. Individuals with cardiovascular comorbidities lose this benefit of premorbid statin use. Statins, as possible protective agents in head trauma, warrant further study.
authors: Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland 21218, USA. eschnei1@jhmi.edu
authors: Eric B
authors: EB
authors: Schneider
authors: David T
authors: DT
authors: Efron
authors: Ellen J
authors: EJ
authors: MacKenzie
authors: Frederick P
authors: FP
authors: Rivara
authors: Avery B
authors: AB
authors: Nathens
authors: Gregory J
authors: GJ
authors: Jurkovich
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D012044:Regression Analysis; D012306:Risk; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors