Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury

Adil Lokhandwala, Kamil Hanna, Lynn Gries, Muhammad Zeeshan, Michael Ditillo, Andrew - Tang, Mohammad Hamidi, Bellal A Joseph

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)367-372
Number of pages6
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Survival
Length of Stay
Hospital Mortality
Skilled Nursing Facilities
Glasgow Outcome Scale
Glasgow Coma Scale
Intensive Care Units
Abbreviated Injury Scale
Propensity Score
Injury Severity Score
Traumatic Brain Injury
Intracranial Hemorrhages
Craniocerebral Trauma
Anticoagulants
Research Design
Animal Models
Databases
Mortality
Wounds and Injuries

Keywords

  • Neuroinflammation
  • Statins
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. / Lokhandwala, Adil; Hanna, Kamil; Gries, Lynn; Zeeshan, Muhammad; Ditillo, Michael; Tang, Andrew -; Hamidi, Mohammad; Joseph, Bellal A.

In: Journal of Surgical Research, Vol. 245, 01.01.2020, p. 367-372.

Research output: Contribution to journalArticle

Lokhandwala, Adil ; Hanna, Kamil ; Gries, Lynn ; Zeeshan, Muhammad ; Ditillo, Michael ; Tang, Andrew - ; Hamidi, Mohammad ; Joseph, Bellal A. / Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. In: Journal of Surgical Research. 2020 ; Vol. 245. pp. 367-372.
@article{b37f184f5c76405aae76002a0a023e5b,
title = "Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury",
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.",
keywords = "Neuroinflammation, Statins, Traumatic brain injury",
author = "Adil Lokhandwala and Kamil Hanna and Lynn Gries and Muhammad Zeeshan and Michael Ditillo and Tang, {Andrew -} and Mohammad Hamidi and Joseph, {Bellal A}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.jss.2019.07.081",
language = "English (US)",
volume = "245",
pages = "367--372",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

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 A

PY - 2020/1/1

Y1 - 2020/1/1

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.

AB - 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.

KW - Neuroinflammation

KW - Statins

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85070598463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070598463&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.07.081

DO - 10.1016/j.jss.2019.07.081

M3 - Article

VL - 245

SP - 367

EP - 372

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -