{
  "abstract": "Introduction Aneurysmal subarachnoid hemorrhage (SAH) confers high morbidity and mortality. Primary and secondary injury pathophysiology, including neuroinflammatory pathways, result in poor neurologic outcomes for many. Aneurysm formation, growth, rupture, and secondary injury mechanisms have neuroinflammatory contributions. Anti-inflammatory and endothelial stabilizing actions of statins have resulted in attention for use in SAH. Statin use may cause decreased occurrence of SAH. Statins are unlikely to change outcomes if administered after SAH, as shown in the HDS-SAH trial. Pre-event statin use remains under-characterized for effects on outcome of SAH events.Methods We conducted a retrospective cohort study using the IBM MarketScan Commercial Claims and Encounters database, enrolling adult patients 2014 through 2022 with one year of data and a first SAH hospitalization. The exposure of pre-index SAH statin use was analyzed for outcomes on mortality, length of stay, and complications at various timepoints. Binary outcomes were analyzed using logistic regression adjusted models utilizing age, sex, geographic region, year, and comorbidities (hypertension, diabetes, hyperlipidemia, and smoking-related diagnoses). Sensitivity analysis for exposure duration was performed.Results We identified 6021 patients with nontraumatic SAH, including 2843 (47.2%) with stain exposure. Mortality across follow-up was observed in 553 (9.2%). Mortality was higher among statin users compared with non-users within 30 days (7.0% vs 6.1%) through any follow-up (10.6% vs 8.0%). Unadjusted regression analyses suggested higher mortality with pre-index statin exposure (OR 1.36, p=0.00053). This persisted in fully adjusted models including age, sex, hypertension, diabetes, hyperlipidemia, smoking, region, and index year (OR 1.33, p=0.00178). Segregated by time windows, statin exposure was not associated with 30-day mortality in adjusted models (OR 1.15, p=0.21). Vasospasm was observed in 656 (10.9%) and hydrocephalus in 1240 (20.6%). Both were less common among statin users (vasospasm 9.9% vs 11.8%; hydrocephalus 17.2% vs 23.6%). In adjusted analysis, statin use was associated with 16% lower odds of vasospasm (OR 0.84, p=0.039) and 34% lower odds of hydrocephalus (OR 0.66, p=<0.0001). Length of stay was shorter in statin users, with 10.9% reduction in adjusted models. Higher statin exposure resulted in lower odds of vasospasm and hydrocephalus, as well as increased delayed mortality.Discussion In this retrospective analysis, statin exposure appeared correlated to improved short-term outcomes including vasospasm, hydrocephalus, and length of stay. It also correlated to worsened long-term mortality, potentially driven by comorbidities not captured in this study. Dose effect was noted to further support this correlation. Further study is needed to evaluate this effect prospectively.Disclosures T. Duda: None. D. Renedo: None. T. Markarian: None. C. Rivier: None. J.P. Antonios: None. J. Haynes: None. K. Sheth: None. R. Hebert: None.Abstract E-296 Table 1Association of pre-index statin exposure with mortality after subarachnoid hemorrhageModelOutcomeOdds RatioLower Confidence IntervalHigher Confidence IntervalP valueUnadjustedDeath (any follow-up)1.361.141.62<0.001Age + SexDeath (any follow-up)1.371.151.64<0.001Model 3Death (any follow-up)1.321.101.590.002Model 4Death (any follow-up)1.331.111.59<0.001UnadjustedDeath <30 days1.150.941.42>0.05Age + SexDeath <30 days1.180.951.45>0.05Model 3Death <30 days1.130.911.416>0.05Model 4Death <30 days1.140.921.416>0.05UnadjustedDeath <90 days1.231.001.500.04Age + SexDeath <90 days1.251.011.530.03Model 3Death <90 days1.200.971.48>0.05Model 4Death <90 days1.2130.981.49>0.05UnadjustedDeath <180 days1.301.061.58<0.001Age + SexDeath <180 days1.321.081.61<0.001Model 3Death <180 days1.271.031.550.02Model 4Death <180 days1.281.041.570.01Abstract E-296 Table 2Association of pre-index statin exposure with in-hospital complicationsModelOutcomeOdds RatioLower Confidence IntervalUpper Confidence IntervalP ValueBetaPercent ChangeUnadjustedVasospasm0.820.700.970.02Age + SexVasospasm0.760.650.90<0.001Model 3Vasospasm0.800.670.950.01Model 4Vasospasm0.830.700.990.039UnadjustedHydrocephalus0.670.590.76<0.001Age + SexHydrocephalus0.640.560.73<0.001Model 3Hydrocephalus0.660.580.75<0.001Model 4Hydrocephalus0.650.570.74<0.001UnadjustedLength of Stay<0.001-0.10-9.90Age + SexLength of Stay<0.001-0.11-10.44Model 3Length of Stay<0.001-0.11-10.74Model 4Length of Stay<0.001-0.11-10.94",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "T Duda"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "D Renedo"
    },
    {
      "affiliations": [
        "University of Southern California, Los Angeles, CA"
      ],
      "name": "T Markarian"
    },
    {
      "affiliations": [
        "Yale University, New Haven, CT"
      ],
      "name": "C Rivier"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "JP Antonios"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "A Koo"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "J Haynes"
    },
    {
      "affiliations": [
        "Yale University, New Haven, CT"
      ],
      "name": "K Sheth"
    },
    {
      "affiliations": [
        "Neurosurgery, Yale University, New Haven, CT"
      ],
      "name": "R Hebert"
    },
    {
      "affiliations": [
        "Yale University, New Haven, CT"
      ],
      "name": "C Matouk"
    }
  ],
  "title": "E-296 Association of prehospital statin exposure with mortality and in-hospital complications after subarachnoid hemorrhage",
  "uid": "7f9914a3-fb66-5585-82a2-ed467cacbc1a"
}