Wongsripuemtet P.Ohnuma T.Temkin N.Barber J.Komisarow J.Manley G.T.Hatfield J.Treggiari M.M.Colton K.Sasannejad C.Chaikittisilpa N.Grandhi R.Laskowitz D.T.Mathew J.P.Hernandez A.James M.L.Raghunathan K.Miller J.B.Vavilala M.S.Krishnamoorthy V.Mahidol University2026-03-152026-03-152026-04-01Journal of Neurosurgical Anesthesiology Vol.38 No.2 (2026) , 155-160https://repository.li.mahidol.ac.th/handle/123456789/115688OBJECTIVE: 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.MedicineArticleSCOPUS10.1097/ANA.00000000000010632-s2.0-1050319534961537192141024341