Preinjury statin use is associated with a higher risk of multiple organ failure after injury: a propensity score adjusted analysis.

Agrowing body of literature has emerged providing evidence for the beneficial effects attributable to 3-hydroxy-3-methyl-glut aryl-CoA reductase inhibitors (statins).1 Statins are emerging as one of the most frequently prescribed medications in the elderly population, and they have been shown to be effective in reducing low-density lipoprotein cholesterol levels, resulting in protection from cardiovascular morbidity.2 The use of prehospital statins has been shown to be associated with a reduction in mortality and morbidity in critically ill patients with sepsis.3-9 This has been hypothesized to result not from their cholesterol lowering properties but rather from a so-called “pleiotrophic modulation” of the inflammatory cascade.4,10 Statin use has been shown to bring about an attenuation of isoprenoid synthesis, which enhances endothelial function, provides antithrombotic effects, normalizes platelet aggregation, and results in a significant anti-inflammatory effect.10-12 Despite the high prevalence of statin use and the similarities between the inflammatory host response in septic and injured patients, there remains a paucity of literature, which characterizes the effects of prehospital statin use after injury. There exists only a single observational cohort study demonstrating an independent lower risk of mortality associated with preinjury statin (PIS) use after injury,13 whereas the proposed inflammatory modulating effects of PIS use and their association with the development of organ dysfunction and infection risk postinjury remains poorly characterized. We sought to characterize these relevant clinical outcomes and their association with PIS use in a large cohort of severely injured blunt trauma patients. Specifically, we sought to determine the effect of PIS use on multiple organ failure (MOF), the development of nosocomial infection (NI), as well as mortality after injury. We hypothesized that PIS use would be associated with a decreased risk of MOF, NI, and mortality in the severely injured trauma patient.