Association of Preinjury Beta-Blocker Exposure With Brain Injury Biomarkers Following Traumatic Brain Injury.

OBJECTIVE: Beta-blockers have been studied for their impact on traumatic brain injury (TBI). We aimed to examine the association of preinjury beta-blocker exposure with early brain injury biomarker levels and outcomes following TBI. METHODS: We retrospectively studied adults (≥40 y) participating in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. The exposure was preinjury beta-blocker utilization. Primary outcome was blood-based brain injury biomarker levels on day 1 following injury. Secondary outcomes included biomarkers on days 3 and 5, hospital mortality, and the 6-month Glasgow Outcome Scale-Extended. Inverse probability-weighted models assessed the association between preinjury beta-blocker exposure, biomarker levels, and outcomes, stratified by TBI severity. RESULTS: A total of 1185 patients were included, with 101 on preinjury beta-blockers (BB+): 21 in the moderate/severe group and 80 in the mild TBI group. BB+patients were older than BB- in both mild (67 vs. 57 y, P<0.001) and moderate/severe TBI (64 vs. 56 y, P=0.003). Hypertension was more common in BB+patients (78% mild, 67% moderate/severe, P<0.001). Preinjury beta-blocker use was not associated with day 1 biomarker levels. The 6-month GOSE scores in the BB+ moderate/severe TBI were lower, but the effect was marginal (B= -1.20, 95% CI: -2.39 to -0.01, P=0.049). CONCLUSION: Our study did not find a clear association between preinjury beta-blocker exposure and day 1 blood-based brain injury biomarkers or clinical outcomes. These findings warrant confirmation in future studies with larger cohorts.

Duke Scholars

Author Tetsu Ohnuma Anesthesiology, Critical Care Medicine

Author Cina Sasannejad Neurology, Neurocritical Care

Author Joseph P. Mathew Anesthesiology, Cardiothoracic

Author Vijay Krishnamoorthy Anesthesiology, Critical Care Medicine

Author Jordan Komisarow Neurosurgery