title: Statin discontinuation and mortality in an older adult population with traumatic brain injury: A four-year, multi-centre, observational cohort study.
abstract: BACKGROUND
  Statin discontinuation has been investigated in a wide range of diseases and injuries, but there is a paucity of data in the older adult population with traumatic brain injury (TBI). The purpose of this study was to re-examine the extent to which early discontinuation of pre-injury statin (PIS) therapy increases the risk of poor patient outcomes in older adult patients suffering a TBI.
  
  
  METHODS
  This was a retrospective observational cohort study of adult trauma patients with a blunt TBI across three trauma centres over four years. Patients were excluded because of no PIS use, age <55years, or a hospital length of stay (LOS) less than three days. Patients found to be intentionally discontinued from statin therapy within 48h of hospital admission for injury-related reasons were excluded. The primary and secondary outcomes were in-hospital mortality and a hospital LOS ≥1 week. Outcomes were analysed using logistic regression.
  
  
  RESULTS
  There were 266 patients in the continuation group, and 131 in the discontinuation group. The statin discontinuation group had a significantly higher proportion of patients with a moderate or severe head injury, intubation in emergency department (ED), and disposition to the intensive care unit or operating room. Overall, 23 (6%) patients died while in the hospital. After adjusting for ED Glasgow coma scale, the odds of dying in the hospital were not significantly larger for patients having been discontinued from PIS, compared to those who were continued (OR=1.75, 95%CI=0.71-4.31, p=0.22). Among patients who received an in-hospital statin, the median (interquartile range) time between hospital admission and first administration of statin medication did not differ between patients who died and those who survived (22.8h [10.96-28.91] vs. 22.9h [11.67-39.80], p=0.94). There were no significant differences between study groups in the proportion of patients with a hospital length of stay >1 week (continuation=29% vs. discontinuation=36%, p=0.19).
  
  
  CONCLUSIONS
  We did not observe a significantly increased odds of in-hospital mortality following PIS discontinuation, compared to PIS continuation, in an older adult population with TBI. It remains to be seen whether statin discontinuation is a proxy variable for injury severity, or whether it exerts deleterious effects after injury.
authors.affiliation: Swedish Medical Centre, Trauma Research Department, Englewood, CO, USA; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA; The Medical Centre of Plano, Plano, TX, USA; Penrose Hospital, Colorado Springs, CO, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Orlando
authors.affiliation: Swedish Medical Centre, Trauma Research Department, Englewood, CO, USA; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA; The Medical Centre of Plano, Plano, TX, USA; Penrose Hospital, Colorado Springs, CO, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Thomas
authors.affiliation: The Medical Centre of Plano, Plano, TX, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carrick
authors.affiliation: Swedish Medical Centre, Trauma Research Department, Englewood, CO, USA.
authors.forename: D Sue
authors.initials: DS
authors.lastname: Slone
authors.affiliation: St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Mains
authors.affiliation: Swedish Medical Centre, Trauma Research Department, Englewood, CO, USA; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA; The Medical Centre of Plano, Plano, TX, USA; Penrose Hospital, Colorado Springs, CO, USA; Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA. Electronic address: dbaror@ampiopharma.com.
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000401:mortality* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: HMG Co-A reductase inhibitors; Older adult; Statins; Traumatic brain injury