Schneider Eric B, Efron David T, MacKenzie Ellen J, Rivara Frederick P, Nathens Avery B, Jurkovich Gregory J
Division of Acute Care Surgery and Adult Trauma Surgery, Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland 21218, USA.
J Trauma. 2011 Oct;71(4):815-9. doi: 10.1097/TA.0b013e3182319de5.
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.
确定伤前使用他汀类药物是否与中度/重度颅脑外伤老年患者的生存及功能恢复相关。
利用从69家美国医院收集的创伤成本与结局国家研究数据集，评估伤前使用他汀类药物对年龄≥65岁、头部损伤简明损伤评分（AIS）≥3的患者住院死亡率及功能结局的影响。排除入院后24小时内死亡或出现固定散大瞳孔的个体。采用二分法的扩展格拉斯哥预后量表，以恢复到病前主要活动能力来衡量功能结局。多变量回归模型分析他汀类药物使用情况及结局，并对人口统计学、合并症和损伤特征进行控制。
在523名符合条件的个体中，117名（22%）在受伤时使用他汀类药物。使用他汀类药物与住院死亡调整风险降低76%相关（相对风险[RR]=0.24；95%置信区间[CI]，0.08 - 0.69）。在395名存活出院的个体中，303名存活1年，264名有完整的扩展格拉斯哥预后量表评分。他汀类药物使用者和非使用者在3个月时显示出相似的良好恢复风险（RR=0.83；95%CI，0.46 - 1.49）。受伤后12个月，他汀类药物使用者良好恢复的可能性高13%（RR=1.13；95%CI，1.01 - 1.26）。心血管合并症的存在消除了这种影响。
伤前使用他汀类药物与老年创伤性脑损伤患者死亡风险降低及受伤后12个月功能恢复改善相关。有心血管合并症的个体失去了伤前使用他汀类药物的这一益处。他汀类药物作为头部创伤可能的保护剂，值得进一步研究。
