SAN DIEGO – Patients who were on statins prior to sustaining a traumatic brain injury doubled their survival rate over those who were not on the drugs in a retrospective analysis.
The study provides preliminary data that can help set a framework to conduct larger, randomized, controlled trials to further evaluate the role of statins, which have been shown in animal models to improve outcomes after traumatic brain injury (TBI).Adil M. Lokhandwala, MD, said in an interview in advance of the annual clinical congress of the American College of Surgeons. “TBI carries a high incidence, and the mortality and morbidity that comes after an event can be devastating, with sometimes long-term psychosocial consequences for the individuals involved. When it comes to therapy for TBI, currently there is none. All we have at this time is guidelines from the Brain Trauma Foundation that are mainly focused on the management of TBI. These patients have a very high incidence of schizophrenia, depression, and PTSD. These are life-long consequences. Some of the affected can’t hold a job; it can be a very morbid condition.”
In an effort to evaluate the effect of pre-injury statins on outcomes after TBI, Dr. Lokhandwala, a general surgery resident at the University of Arizona, Tucson, and his associates identified all patients aged 40 years and older from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) III database with a diagnosis of TBI and ICU length of stay of greater than 24 hours. They divided patients into two groups: those who were on statins and those who were not. The primary outcome was in-hospital survival. Secondary outcomes measures were hospital length of stay and ICU length of stay.
Dr. Lokhandwala, who is also a commissioned officer with the U.S. Army Reserves, reported results from 918 patients with a TBI. Their mean age was 55 years, 76% were white, and 22% were on statins. The overall in-hospital survival rate was 78.6%, while the median Glasgow Coma Scale was 12. The median hospital length of stay and ICU length of stay were 9.1 and 7.2 days, respectively. The researchers observed that compared with patients who were not on statins, those on statin therapy had significantly higher rates of survival (88% vs. 68.4%; P less than .001). However, there was no difference in hospital or ICU length of stay between the two groups (P = .19 and P = .39, respectively). On regression analysis after controlling for confounding factors, statin use was found to be an independent predictor of survival (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P less than .001).
“Even though we isolated our patients to TBI, there could have been other causes of their mortality, like a pulmonary embolism or a myocardial infarction,” Dr. Lokhandwala said. “We need to conduct a randomized, controlled trial to follow these individuals and see what their actual mortality is and look at their psychosocial outcomes to see if there’s a long-term benefit to statins. Do these people have decreased incidence of PTSD or are they more functional? Is it easier for them to hold a job or develop social relationships? The impact of post-injury statin use could also be studied.”
He went on to note that many studies have shown that aggressive team-based rehabilitation can improve outcomes in TBI patients. “Would we be able to include statin use in such a program to see if statins further improve outcomes faster or are there individuals that don’t benefit as much?” Dr. Lokhandwala asked. “This study sets up a framework to show that there is a strong association, and take this further in a more structured trial to see if there is any potential for therapeutic use in TBI.”
Dr. Lokhandwala reported having no financial disclosures.