Characteristics and outcomes in atorvastatin therapy for chronic subdural hematoma: a national, observational real-world study in China, 2019-2024.

Abstract

The incidence of chronic subdural hematoma (cSDH) is increasing in the aging population worldwide, where the success of conventional surgical decompression is complicated by high rates of complications and recurrence. The anti-inflammatory properties of atorvastatin make it an attractive, low-cost, and safe medical approach, but limited evidence exists regarding its clinical benefit in cSDH. We aim to evaluate temporal trends, disease characteristics, and clinical outcomes associated with atorvastatin treatment for cSDH in real-world settings in China. This was a multicenter registry study of the Chronic Subdural Hematoma (MR-CSDH) in China. Adults received either 20 mg of atorvastatin or not daily for 8 weeks and were followed up for an additional 6 months at 61 medical centers between November 1, 2019 and October 30, 2024. The primary outcome was good functional outcome defined by modified Rankin scale scores of 0-3 at 6 months. Secondary outcomes included good clinical outcomes and recurrence at 3 months, mortality and recurrent SDH at 6 months, healthcare costs, suspected statin-related adverse events, and length of hospital stay. Logistic regression and propensity score matching (PSM) were used for analysis. The trial was registered with Chinese Clinical Trial Registry, identifier ChiCTR2200057179. A total of 2422 patients were included (mean [SD] age: 70.3 [14.5] years; 453 [18.7%] female), of whom 1777 (73.4%) received atorvastatin therapy. The proportion of cSDH patients receiving conservative treatment tripled, rising from 14.7% in 2019 to 53.4% in 2024 (P for trend <0.001), while the proportion undergoing surgical treatment significantly declined (P < 0.001). Moreover, the proportion of cSDH patients prescribed statin medication showed a steady temporal increase. Compared to patients who did not receive atorvastatin, those treated with atorvastatin had a higher likelihood of good functional outcome (odds ratio 1.93, 95% confidence interval [CI] 1.29-2.89), lower risk of mortality (hazard ratio 0.24, 95% CI 0.06-0.92) at 6 months, and reduced length of hospital stay (mean difference [MD] -1.69, 95% CI [-3.01, -0.37], P = 0.012) and decreased hospitalization costs (MD -0.79, 95% CI [-1.31, -0.28], P = 0.003). However, the between-group differences in recurrent SDH (at 3 and 6 months) and adverse events were not significantly different. This study indicates a positive association between atorvastatin use and good clinical outcomes in patients with cSDH, and is increasingly being used in China. This study was funded by the National Natural Science Foundation of China (No. 82071390, 82001323, 82101434), the Science and Technology Project of Tianjin (No. 19YFZCSY00650), Tianjin Key Medical Discipline (Specialty) Construction Project, and the Zhao Yi-Cheng Medical Science Foundation.