Association of Angiotensin-Converting Enzyme Inhibitors with Increased Mortality Among Patients with Isolated Severe Traumatic Brain Injury

• Published in: Neurocritical care Vol. 31; no. 3; pp. 507 - 513
• Main Authors: Catapano, Joshua S., Chapman, Alistair J., Dull, Matthew, Abbatematteo, Joseph M., Horner, Lance P., Godzik, Jakub, Brigeman, Scott, Morgan, Clinton D., Whiting, Alexander C., Lu, Minggen, Zabramski, Joseph M., Fraser, Douglas R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2019; Springer Nature B.V
• Subjects: Abbreviated Injury Scale; Adrenergic beta-Antagonists - therapeutic use; Adult; Age; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Blood Pressure; Brain Injuries, Traumatic - mortality; Craniotomy - statistics & numerical data; Critical Care Medicine; Diffuse Axonal Injury - epidemiology; Enzymes; Epidural; Female; Glasgow Coma Scale; Hematoma; Hematoma, Subdural - epidemiology; Hospital Mortality; Humans; Injury Severity Score; Intensive; Intensive care; Internal Medicine; Intracranial pressure; Length of stay; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Original Work; Protective Factors; Regression analysis; Retrospective Studies; Risk Factors; Trauma; Traumatic brain injury; United States - epidemiology; Ventilators; United States; United States > US; Angiotensin-converting enzyme inhibitor; Traumatic brain injury; Isolated; β-Blockers; Mortality
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-019-00755-y

Background Traumatic brain injury (TBI) is associated with one-third of all deaths from trauma. Preinjury exposure to cardiovascular drugs may affect TBI outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) exacerbate brain cell damage and worsen functional outcomes in the laboratory setting. β-blockers (BBs), however, appear to be associated with reduced mortality among patients with isolated TBI. Objective Examine the association between preinjury ACEI and BB use and clinical outcome among patients with isolated TBI. Methods A retrospective cohort study of patients age ≥ 40 years admitted to an academic level 1 trauma center with isolated TBI between January 2010 and December 2014 was performed. Isolated TBI was defined as a head Abbreviated Injury Scale (AIS) score ≥ 3, with chest, abdomen, and extremity AIS scores ≤ 2. Preinjury medication use was determined through chart review. All patients with concurrent BB use were initially excluded. In-hospital mortality was the primary measured outcome. Results Over the 5-year study period, 600 patients were identified with isolated TBI who were naive to BB use. There was significantly higher mortality ( P  = .04) among patients who received ACEI before injury (10 of 96; 10%) than among those who did not (25 of 504; 5%). A multivariate stepwise logistic regression analysis revealed a threefold increased risk of mortality in the ACEI cohort ( P  < .001), which was even greater than the twofold increased risk of mortality associated with an Injury Severity Score ≥ 16. A second analysis that included patients who received preinjury BBs ( n  = 98) demonstrated slightly reduced mortality in the ACEI cohort with only a twofold increased risk in multivariate analysis ( P  = .05). Conclusions Preinjury exposure to ACEIs is associated with an increase in mortality among patients with isolated TBI. This effect is ameliorated in patients who receive BBs, which provides evidence that this class of medications may provide a protective benefit.