Pre-morbid Statin Use and Mortality in Trauma: A Systematic Review and Meta-analysis

Background: Secondary injury after trauma is responsible for significant morbidity and mortality. Inflammation appears to play a central role. Evidence suggests 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 aim of this systematic review and meta-analysis was to determine if pre-morbid statin use improved outcome in patients 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. 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). The use of statins before traumatic brain injury (TBI) conferred a mortality risk ratio of 0.60 (95% CI 0.28-1.27). Analysis non-TBI studies yielded a risk ratio of 0.84 [95% CI 0.56-1.27]. Conclusion: Current data failed to demonstrate a statistically significant benefit to pre-morbid statin use following serious injury. As this may be due to a number of confounding factors, further dedicated study is warranted to confirm or refute the findings of the beneficial effect of statins in trauma.