Outcomes of Preinjury Use of Statins in Patients with Traumatic Brain Injury: A Systematic Review and Meta-analysis

BACKGROUND: No completely effective pharmacotherapies have been developed to improve the outcomes of traumatic brain injury (TBI). Given the reporting of cohort studies suggesting that preinjury statin use may reduce TBI-associated mortality, this study aimed to evaluate the effects of statin use in patients with TBI. METHODS: This study was performed according to the PRISMA guidelines. The PubMed, Embase, Cochrane Central, Web of Science, and China National Knowledge Infrastructure databases were searched from inception until April 13, 2021, using a search strategy that included 2 main terms: "statins" and "traumatic brain injury." The outcomes were mortality, hospital length of stay, and intensive care unit length of stay, which were evaluated using a random-effects model and represented by the pooled risk ratio with 95% confidence intervals. RESULTS: The search results identified 7 eligible studies, with a total of 111,935 patients with brain injury. Preinjury statin use in patients with TBI was associated with a significantly decreased risk of mortality compared with that in nonusers (risk ratio, 0.75; 95% confidence interval, 0.59-0.94; I-2 = 53%). Subgroup analysis showed that statin withdrawal might increase mortality. Sensitivity analysis showed that the results were stable and robust. CONCLUSIONS: Preinjury statin use may contribute to mortality reduction in patients with TBI, whereas statin withdrawal might increase mortality. In clinical management, statin use should not be discontinued after TBI.