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Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients
David T Efron1, Gary Sorock, Elliott R Haut
1Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. defron1@jhmi.edu
Background:
Recent evidence demonstrates improved survival for septic and bacteremic patients receiving 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). Victims of severe traumatic injury share similar inflammatory cascades to those seen in septic patients. We hypothesized that elderly (aged >/=65 years) trauma patients might derive a similar outcome benefit from preinjury statin use.
Methods:
Using the National Study on the Costs and Outcomes of Trauma database (collected from 69 hospitals) we conducted a retrospective observational cohort study of the effects of preinjury statin use on in-hospital mortality. Elderly patients were identified as having suffered moderate-to-severe traumatic injury (Abbreviated Injury Scale score >/=3). All hospital deaths and a sample of patients discharged alive were included for study. Multivariable analysis was performed including statin use, sex, age, comorbidities (myocardial infarction, stroke, arrhythmia, peripheral vascular disease, congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, renal disease), smoking, beta-blocker use, New Injury Severity Score, Glasgow Coma Scale, cerebral midline shift, trauma center treatment, shock, and infection.
Results:
A total of 1,224 elderly patients met the inclusion criteria for analysis of these patients, 21.1% were on statin therapy at the time of injury. Preinjury statin treatment was associated with a 67% reduction in the multivariable adjusted odds of in-hospital mortality (compared with statin nonusers; odds ratio, 0.33, 95% confidence interval [CI]: 0.12-0.92, p = 0.04). When stratified by the absence and presence of cardiovascular comorbidities, multivariable adjusted odds for statin use were 0.30 (95% CI: 0.10-0.91, p = 0.03) and 1.4 (95% CI: 0.72-2.72, p = 0.31), respectively.
Conclusion:
Preinjury statin use in elderly patients is associated with a significant survival benefit after major trauma, but only in patients without preexisting cardiovascular disease.
