Pre-morbid statin use and mortality in trauma: a systematic review and meta-analysis.

PURPOSE: Secondary injury after trauma is responsible for significant morbidity and mortality. Inflammation appears to play a central role. Some evidence proposes that statins (HMG-CoA reductase inhibitors) may modulate this inflammation via their pleiotropic properties (non-cholesterol lowering effects). These include suppression of complement activation, vasodilation and inhibition of platelet function and aggregation. The purpose of this systematic review and meta-analysis was to investigate whether pre-morbid statin use is associated with differences in outcomes after trauma.

METHODS

MEDLINE, EMBASE, Central, Google Scholar, clinicaltrials.gov, clinicaltrialsregister.eu and the German clinical trials register were searched for articles published between 01.09.1987 and 31.12.2023 examining pre-morbid statin use on outcomes after trauma.

RESULTS

After removal of duplicates, 623 records for abstract review were identified, of which nine were included in the systematic review and eight the meta-analysis. All studies were retrospective and most did not confirm in-hospital administration of pre-morbid statins. All had a high risk of bias. Grading of Recommendations Assessment indicated a very low certainty of results. When considering pre-morbid statin use in all types of trauma, the overall mortality risk ratio was 0.66 (95% CI 0.37–1.17) with high heterogeneity (I2 = 99%). The use of statins before traumatic brain injury (TBI) indicated a mortality risk ratio of 0.60 (95% CI 0.28–1.27, I2 = 96%). Analysis non-TBI studies yielded a risk ratio of 0.84 [95% CI 0.56–1.27].

CONCLUSION

In a limited meta-analysis, data failed to demonstrate an association between pre-morbid statin use following serious injury. As this may be due to a heterogeneity in data, variable study population, and a number of confounding factors, further dedicated study is warranted to clarify whether observed associations reflect pharmacologic effects.