Premorbid Statin Use Is Associated With Improved Survival and Functional Outcomes in Older Head-Injured Individuals

Abstract

To determine whether preinjury statin use is associated with survival and functional recovery in older adult victims of moderate/severe head trauma. 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. 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. 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.