- Patients with isolated severe traumatic brain injury (TBI) had higher risk of death if they had been using angiotensin-converting enzyme inhibitors (ACEIs) before their injury, but this risk was attenuated for those also using β-blockers.
Why this matters
- TBI has considerable morbidity, mortality, and medical cost.
- Some evidence suggests β-blockers are neuroprotective.
- Compared with nonusers, patients using ACEIs before their injury had twice the in-hospital mortality rate (10.4% vs 5%; P=.04).
- Risk associated with ACEI use was more than tripled in multivariate stepwise logistic regression analysis (aOR, 3.66; P<.001>
- Magnitude of increase exceeded that seen with Injury Severity Score of 16 or higher (aOR, 2.47; P=.04).
- However, in a second analysis additionally including 98 patients receiving β-blockers before their injury, adverse effect of preinjury ACEI use was attenuated (aOR, 2.27; P=.05).
- Retrospective cohort study of 600 patients age 40 years or older admitted to an academic level 1 trauma center over 5-year period with isolated severe TBI, not receiving β-blockers.
- Main outcome: in-hospital mortality.
- Funding: None.
- Residual and unmeasured confounding.
- Causes of death not evaluated.