ABSTRACT
INTRODUCTION: Traumatic brain injury (TBI) is a global concern associated with high mortality and morbidity. Costs to individuals and society are extensive due to poor recovery, long-term disability and the young age group affected. Statins have emerged as potential therapeutic agents in TBI. This study aimed to investigate the protective effect of statins in severe TBI. METHODS: This case-control study included adults with severe TBI. A sliding dichotomy approach was used to dichotomize mortality at 14-days and Glasgow Outcome Score (GOS) at 6 months. Logistic regression analysis was used to calculate the odds ratios (OR) for 14-day mortality and 6-month GOS. RESULTS: Equivalent cohorts of 59 age- and sex-matched statin and non-statin users were selected, resulting in population of 118 (mean age = 70.2 years, SD = 10.3), with a median Glasgow Coma Score of 5. Statins did not reduce the likelihood of mortality at 14 days (adjusted OR = 1.23, p = 0.68) or unfavourable outcome at 6 months (adjusted OR = 1.19, p = 0.78). CONCLUSIONS: Despite increasing evidence for benefit of statins in TBI, this study in an Asian population does not support this association, demonstrating no significant improvement in outcome for statin users. Further research is required to understand the mechanisms and impact of statins in TBI.
Subject(s)
Brain Injuries, Traumatic/diagnosis , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Aged , Aged, 80 and over , Case-Control Studies , Databases, Factual , Female , Glasgow Outcome Scale , Humans , Hypercholesterolemia/drug therapy , Injury Severity Score , Male , Middle Aged , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
An accurate prognostic model is extremely important in severe traumatic brain injury (TBI) for both patient management and research. Clinical prediction models must be validated both internally and externally before they are considered widely applicable. Our aim is to independently externally validate two prediction models, one developed by the Corticosteroid Randomization After Significant Head injury (CRASH) trial investigators, and the other from the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) group. We used a cohort of 300 patients with severe TBI (Glasgow Coma Score [GCS] ≤8) consecutively admitted to the National Neuroscience Institute (NNI), Singapore, between February 2006 and December 2009. The CRASH models (base and CT) predict 14 day mortality and 6 month unfavorable outcome. The IMPACT models (core, extended, and laboratory) estimate 6 month mortality and unfavorable outcome. Validation was based on measures of discrimination and calibration. Discrimination was assessed using the area under the receiving operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and Cox calibration regression analysis. In the NNI database, the overall observed 14 day mortality was 47.7%, and the observed 6 month unfavorable outcome was 71.0%. The CRASH base model and all three IMPACT models gave an underestimate of the observed values in our cohort when used to predict outcome. Using the CRASH CT model, the predicted 14 day mortality of 46.6% approximated the observed outcome, whereas the predicted 6 month unfavorable outcome was an overestimate at 74.8%. Overall, both the CRASH and IMPACT models showed good discrimination, with AUCs ranging from 0.80 to 0.89, and good overall calibration. We conclude that both the CRASH and IMPACT models satisfactorily predicted outcome in our patients with severe TBI.
