Doerrfuss Jakob I, Abdul-Rahim Azmil H, Siegerink Bob, Nolte Christian H, Lees Kennedy R, Endres Matthias, Kasner Scott E, Scheitz Jan F
Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health, BIH, Berlin, Germany.
Eur Stroke J. 2020 Mar;5(1):85-93. doi: 10.1177/2396987319889258. Epub 2019 Nov 25.
Recent data suggest that statin use after intracerebral haemorrhage might be beneficial. However, data on the effects of early in-hospital statin exposure are lacking. Therefore, we sought to assess whether (1) early statin exposure during the acute phase after intracerebral haemorrhage and (2) early continuation of prevalent statin use are associated with favourable functional outcome.
Data were obtained from the Virtual International Stroke Trials Archive. Patients were categorised according to use patterns of statins during this early in-hospital phase (continuation, discontinuation or new initiation of statins). Univariate and multivariable analyses were conducted to explore the association between early statin exposure and functional outcome.
A total of 919 patients were included in the analysis. Early in-hospital statin exposure (n = 89, 9.7%) was associated with better functional outcome (modified Rankin Scale ≤ 3) compared with 790 patients without statin exposure before or early after the event (66% versus 47%, adjusted OR 2.1, 95% confidence interval 1.3-3.6). Compared with patients without exposure to statins before and early after the event, early continuation of statin therapy (n = 57) was associated with favourable functional outcome (adjusted odds ratio 2.6, 95% confidence interval 1.3-5.2). The association between early continuation of statins and outcome remained robust in sensitivity analyses restricted to patients able to take oral medication within 72 h and one-week survivors.
It is possible that part of the observed associations are not due to a protective effect of statins but are confounded by indication bias.
Statin exposure and continuation of prevalent statin therapy early after intracerebral haemorrhage are associated with favourable functional outcome after 90 days.
近期数据表明，脑出血后使用他汀类药物可能有益。然而，关于住院早期使用他汀类药物的影响的数据尚缺乏。因此，我们试图评估：（1）脑出血急性期早期使用他汀类药物以及（2）早期继续使用现有的他汀类药物是否与良好的功能预后相关。
数据来自虚拟国际卒中试验档案库。根据患者在住院早期他汀类药物的使用模式（继续使用、停用或新开始使用他汀类药物）进行分类。进行单因素和多因素分析以探讨早期使用他汀类药物与功能预后之间的关联。
共有919例患者纳入分析。与事件发生前或早期未使用他汀类药物的790例患者相比，住院早期使用他汀类药物（n = 89，9.7%）与更好的功能预后（改良Rankin量表≤3）相关（66%对47%，校正比值比2.1，95%置信区间1.3 - 3.6）。与事件发生前及早期未使用他汀类药物的患者相比，早期继续使用他汀类药物治疗（n = 57）与良好的功能预后相关（校正比值比2.6，95%置信区间1.3 - 5.2）。在仅限于能够在72小时内口服药物的患者和1周幸存者的敏感性分析中，早期继续使用他汀类药物与预后之间的关联仍然很强。
部分观察到的关联可能并非由于他汀类药物的保护作用，而是受到指征偏倚的混淆。
脑出血后早期使用他汀类药物及继续使用现有的他汀类药物治疗与90天后良好的功能预后相关。
