Impact of Pre-injury Statin Use on Mortality and Short-Term Clinical Outcomes Following Intracerebral Hemorrhage: A Propensity-Matched Cohort Study

Background Intracerebral hemorrhage (ICH) is associated with high mortality and limited therapeutic options. The impact of statin therapy on outcomes following ICH remains controversial. Methods A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adult patients (≥18 years) with nontraumatic ICH were identified and stratified based on statin use within three months prior to the index event. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medication use. The primary outcome was 30-day mortality. Secondary outcomes included ICU admission or mechanical ventilation, external ventricular drain (EVD) placement, seizures, and craniotomy or shunt procedures. Results After matching, 82,755 patients were included in each cohort. Pre-injury statin use was associated with significantly lower mortality (13.4% vs 19.7%; risk ratio (RR) 0.68, 95% CI 0.66-0.70, p<0.001). Statin use was also associated with lower rates of ICU admission or mechanical ventilation (10.9% vs 13.7%; RR 0.80, p<0.001) and EVD placement (4.0% vs 4.6%; RR 0.87, p<0.001). Rates of seizures were similar between groups. Statin users had slightly higher rates of craniotomy or shunt procedures (0.8% vs 0.6%; RR 1.33, p<0.001). Conclusion Pre-injury statin use was associated with reduced mortality and improved short-term outcomes following intracerebral hemorrhage. These findings demonstrate an association between pre-injury statin use and lower mortality and differences in short-term clinical outcomes following intracerebral hemorrhage. Given the retrospective observational design, causality cannot be established.