Preinjury Statin Therapy and Outcomes After Traumatic Brain Injury

BACKGROUND AND OBJECTIVES: Statins have pleiotropic and potentially neuroprotective effects, but clinical evidence in traumatic brain injury (TBI) remains inconsistent. We examined the association between preinjury statin use and short-term outcomes after TBI. METHODS: We conducted a nationwide retrospective cohort study using linked Finnish healthcare registries. All patients aged ≥16 years with a first TBI admission between 1 January 2005 and 31 December 2018 were included. Preinjury statin exposure was defined by pharmacy purchases within 90 days before admission and classified by solubility (lipophilic/hydrophilic) and intensity (high/nonhigh). Primary outcomes were mortality at 30 days and 1 year; secondary outcomes were acute neurosurgical operations and hospital length of stay. Propensity score matching (1:1) and multivariable regression adjusted for demographics, comorbidities, vitamin K antagonist use, skull/facial fracture, admission site, and year were used. RESULTS: Among 58 489 patients (median 65 years; 55.7% men), 10 877 (18.6%) used statins before injury. After matching, 10 131 balanced pairs were analyzed. The 30-day mortality was 8.9% vs 10.3% (hazard ratio 0.86, 95% CI, 0.81-0.92), and the 1-year mortality was 17.9% vs 22.0% (hazard ratio 0.80, 95% CI, 0.76-0.83). Statin users had lower odds of neurosurgical operations (7.1% vs 8.1%; odds ratio 0.87, 95% CI, 0.78-0.96) and shorter admissions (mean 17.0 vs 19.5 days). Results were consistent across subgroups. Lipophilic and high-intensity statins were associated with stronger 1-year survival benefit. CONCLUSION: Preinjury statin therapy was associated with lower mortality, fewer acute neurosurgical operations, and shorter hospital stays after injury. These findings support prospective evaluation of statins as potential neuroprotective therapy in TBI.