Preinjury statin use is associated with a higher risk of multiple organ failure after injury: a propensity score adjusted analysis

Abstract

Background: Recent studies suggest that statin use may improve outcome in critically ill patients. This has been attributed to the pleiomorphic effect and modulation of inflammatory mediators that occurs with statin use. We sought to determine whether preinjury statin (PIS) use was associated with improved outcome in severely injured blunt trauma patients.

Methods: Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt injured adults with hemorrhagic shock. Patients aged 55 years and older were analyzed. Those with isolated traumatic brain injury, cervical cord injury, and those who survived <24 hours were excluded. A propensity score predicting statin use was created using logistic regression. Cox proportional hazard regression was then used to evaluate the effects of PIS use on mortality and the development of multiple organ failure (MOF, multiple organ dysfunction syndrome >5) and nosocomial infection (NI) after adjusting for important injury characteristics and the propensity of taking PISs.

Results: Overall mortality and MOF rates for the study cohort (n = 295) were 21% and 50%, respectively. Over 24% of patients (n = 71) reported PIS use. Kaplan-Meier analysis revealed no difference in NI or mortality over time but did show a significant higher incidence of MOF in those with PIS use (p = 0.04). Regression analysis verified PIS was independently associated with an 80% higher risk of MOF (hazard ratio: 1.8; 95% confidence interval, 1.1-2.9) and was found to be one of the strongest independent risk factors for the development of MOF.

Conclusion: PIS use was independently associated with a higher risk of MOF postinjury. These results are contrary to previous analyses. The protective effect of statins may be lost in the severely injured, and modulation of the inflammatory response may result in higher morbidity. Further studies are required to better understand the impact and potential therapeutic utility of this commonly prescribed medication both before and after injury.

Figures

Figure 1

Kaplan-Meier time-to-event analysis for the development of multiple organ failure comparing those patient with and without preinjury statin use.

Figure 2

Independent hazard ratios depicting the risk of developing nosocomial infection (NI), multiple organ failure (MOF), and mortality associated with preinjury statin (PIS) use through Cox proportional hazard regression analysis (**statistically significant). Additional covariates included in the regression model: propensity score for PIS use, individual maximum abbreviate injury scores (AIS, head, neck, chest, abdomen, extremity, skin), APACHE II score, ED Glasgow Coma Score, 12-hour blood, crystalloid, platelet, and cryoprecipitate requirements, presenting base deficit and ED coagulation status (INR), and the requirement of early operative intervention (exploratory laparotomy or thoracotomy or sternotomy).