title: Prehospital HMG Co-A reductase inhibitor use and reduced mortality in hemorrhagic shock due to trauma.
abstract: BACKGROUND
  3-Hydroxy-3-methyl-glutaryl Co-A reductase inhibitors (HMG Co-A reductase inhibitors, statins) are commonly used medications for the control of serum cholesterol. Recent data suggests that these medications also modify the inflammatory pathways in sepsis, septic shock, and hemorrhagic shock due to ruptured abdominal aortic aneurysms. Statin use in hemorrhagic shock due to trauma, however, has conflicting data, with one study showing improvement, but only in certain subsets of patients.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients from our institution's trauma registry database from January 2000 to December 2008. We included patients with an age greater than 45 years and an Injury Severity Score (ISS) greater than 15 with evidence of shock as follows: hypotension, elevated serum lactate, base deficit, metabolic acidosis, or objective evidence of end-organ malperfusion. We excluded patients with devastating head injury, patients with pre-existing advance directives directing against life-sustaining measures, patients for whom family or health care proxies withdrew support in 24 h or less, and patients who succumbed to their injuries in the first 24 h in the hospital. We compared age, gender, mortality, statin use, aspirin use, and Sequential Organ Failure Assessment (SOFA) scores.
  
  
  RESULTS
  Mortality in the group without prehospital statin use was 38.1% (95% confidence interval [CI]: 28.4-48.8%) and mortality in the group with prehospital statin use was 8.3% (95% CI: 2.13-22.5%, P = 0.0009). The absolute risk reduction was 29.8% and the relative risk reduction was 78.1%. Survivors were statistically significantly younger than nonsurvivors in the group without prehospital statin use, but not in the group with documented prehospital statin use. There was no similar benefit to aspirin use. There were no significant differences in the SOFA scores, hospital length of stay (HLOS), or intensive care unit length of stay (ICU LOS) between statin users and nonusers.
  
  
  CONCLUSIONS
  Prehospital HMG Co-A reductase use was associated with improved survival in a population with severe trauma and evidence of ongoing hemorrhagic shock.
authors.affiliation: Department of Surgery, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06103, USA. jfeeney@stfranciscare.org.|University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA. jfeeney@stfranciscare.org.
authors.forename: J M
authors.initials: JM
authors.lastname: Feeney
authors.affiliation: Department of Traumatology and Emergency Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
authors.forename: V
authors.initials: V
authors.lastname: Jayaraman
authors.affiliation: University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
authors.forename: J
authors.initials: J
authors.lastname: Spilka
authors.affiliation: Department of Surgery, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06103, USA.|University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Shapiro
authors.affiliation: Department of Surgery, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06103, USA.|University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ellner
authors.affiliation: Department of Surgery, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06103, USA.|University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Marshall
authors.affiliation: Department of Surgery, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06103, USA.|University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Jacobs
keywords: Abdominal trauma; Inflammation; Polytrauma; Shock
references.citation: J Virol. 2007 Feb;81(3):1492-501
references.pmid: 17108035
references.citation: J Am Coll Surg. 2009 Jul;209(1):41-6
references.pmid: 19651061
references.citation: Intensive Care Med. 2006 Aug;32(8):1248-51
references.pmid: 16788803
references.citation: Circulation. 2004 Aug 17;110(7):880-5
references.pmid: 15289367
references.citation: Resuscitation. 2007 Jul;74(1):166-74
references.pmid: 17353078
references.citation: Arterioscler Thromb Vasc Biol. 2005 Nov;25(11):2335-42
references.pmid: 16166567
references.citation: J Cardiovasc Pharmacol. 2005 Mar;45(3):247-52
references.pmid: 15725950
references.citation: Arterioscler Thromb Vasc Biol. 2001 Jan;21(1):115-21
references.pmid: 11145942
references.citation: Stroke. 2006 Jul;37(7):1923-32
references.pmid: 16741184
references.citation: Biochem Biophys Res Commun. 1997 Feb 13;231(2):437-41
references.pmid: 9070296
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Mol Pharmacol. 2006 Mar;69(3):960-7
references.pmid: 16317111
references.citation: Ann Pharmacother. 2007 Apr;41(4):647-52
references.pmid: 17389664
references.citation: Kidney Int. 2006 May;69(9):1535-42
references.pmid: 16557230
references.citation: J Trauma. 2008 Jan;64(1):66-73; discussion 73-4
references.pmid: 18188101
references.citation: Atherosclerosis. 2006 Oct;188(2):265-73
references.pmid: 16375908
references.citation: Chest. 2003 Aug;124(2):740-3
references.pmid: 12907568
references.citation: Shock. 2004 Mar;21(3):271-5
references.pmid: 14770041