Silva Marques Joana, Ennis Giovana, Venade Gabriela, João Soares Rita, Monteiro Nuno, Gomes Ana
Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT.
Stroke Unit, Centro Hospitalar Tondela-Viseu, Viseu, PRT.
Cureus. 2021 Apr 11;13(4):e14421. doi: 10.7759/cureus.14421.
Aim The effect of statins is well established in cardiac and cerebrovascular diseases. However, its impact on intracerebral hemorrhage (ICH) is unclear. We aim to identify an association of pre-ICH statin treatment and statin use during admission for ICH with functional outcome at discharge and 30-day mortality. Material and methods A retrospective cohort study was held in patients with ICH admitted to our stroke unit over a year period. Demographic characteristics, risk factors and cardiovascular diseases, Glasgow Coma Scale (GCS), National Institutes of Health Stroke Score (NIHSS), systolic blood pressure (SBP) at admission, cholesterol levels and radiologic findings were analyzed to explore the association between pre-ICH and inpatient statin use with outcomes. The primary endpoint was functional outcome defined as modified Rankin Score (mRS) at discharge and 30-day mortality. We performed a univariate analysis and the variables with statistical significance were included in a multivariate analysis to control for confounding covariates. Results The study included 78 patients, 33 (42.31%) had previous statin intake history, of which 13 (39.39%) maintained statin intake during hospitalization. Regarding functional outcome we did not report a statistically significant difference between groups. In the "pre-ICH statin use" group a decreased 30-day mortality (6.06%, p = 0.009) was observed. In this group it was also noted higher antiplatelet medication use (33.33%, p = 0.006), higher GCS at admission (13-15: 84.38%, p = 0.018) and deep ICH (81.82%, p = 0.030). However, 30-day mortality had no impact in multivariate regression (Odds ratio (OR) 4.535, 95% Confidence Interval (CI) = 0.786-26.173, p = 0.091). In the group that maintained statin treatment during hospitalization no deaths were registered (p = 0.020) and there was no association with functional status. Multivariate regression analysis was not performed due to sample size. Conclusion The only association demonstrated in this study was lower 30-day mortality with pre-ICH statin use and continued statin treatment during admission. However, this was not confirmed by multivariate regression analysis. There were no differences between groups concerning cholesterol values, results that can be explained by the pleiotropic and immunomodulatory effect of statins. However, prospective studies are needed to prove the benefit of the statins in ICH.
目的 他汀类药物在心血管疾病中的作用已得到充分证实。然而，其对脑出血（ICH）的影响尚不清楚。我们旨在确定脑出血前他汀类药物治疗及脑出血住院期间使用他汀类药物与出院时功能结局和30天死亡率之间的关联。材料与方法 对我院卒中单元收治的脑出血患者进行了为期一年的回顾性队列研究。分析人口统计学特征、危险因素和心血管疾病、格拉斯哥昏迷量表（GCS）、美国国立卫生研究院卒中量表（NIHSS）、入院时收缩压（SBP）、胆固醇水平和影像学检查结果，以探讨脑出血前及住院期间使用他汀类药物与结局之间的关联。主要终点是出院时的功能结局，定义为改良Rankin量表（mRS）评分和30天死亡率。我们进行了单因素分析，并将具有统计学意义的变量纳入多因素分析以控制混杂协变量。结果 该研究纳入78例患者，33例（42.31%）有他汀类药物服用史，其中13例（39.39%）住院期间持续服用他汀类药物。关于功能结局，我们未报告两组之间有统计学显著差异。在“脑出血前使用他汀类药物”组中，观察到30天死亡率降低（6.06%，p = 0.009）。在该组中还注意到抗血小板药物使用比例更高（33.33%，p = 0.006）、入院时GCS评分更高（13 - 15分：84.38%，p = 0.018）以及深部脑出血比例更高（81.82%，p = 0.030）。然而，30天死亡率在多因素回归分析中无影响（比值比（OR）4.535，95%置信区间（CI）= 0.786 - 26.173，p = 0.091）。在住院期间持续接受他汀类药物治疗的组中未记录到死亡（p = 0.020），且与功能状态无关联。由于样本量原因未进行多因素回归分析。结论 本研究中唯一显示的关联是脑出血前使用他汀类药物及住院期间持续使用他汀类药物治疗可降低30天死亡率。然而，多因素回归分析未证实这一点。两组之间胆固醇值无差异，这一结果可由他汀类药物的多效性和免疫调节作用来解释。然而，需要前瞻性研究来证明他汀类药物在脑出血中的益处。
