A Propensity Score Analysis of the Impact of Dexamethasone Use on Delayed Cerebral Ischemia and Poor Functional Outcomes After Subarachnoid Hemorrhage
| Autor: | Aditya S. Pandey, Ron Ball, Teresa L. Jacobs, Jeffrey J. Fletcher, Nathaniel Mohney, B. Gregory Thompson, Kyle M. Sheehan, Craig A. Williamson, Venkatakrishna Rajajee, Edward D. Rothman |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Subarachnoid hemorrhage Brain Edema Dexamethasone Neurosurgical Procedures Brain Ischemia Cerebral edema 03 medical and health sciences Postoperative Complications 0302 clinical medicine Cerebral vasospasm Risk Factors Modified Rankin Scale Odds Ratio medicine Humans Vasospasm Intracranial Registries 030212 general & internal medicine Propensity Score Glucocorticoids Aged Retrospective Studies business.industry Odds ratio Middle Aged Subarachnoid Hemorrhage medicine.disease Confidence interval Logistic Models Treatment Outcome Anesthesia Propensity score matching Female Surgery Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | World Neurosurgery. 109:e655-e661 |
| ISSN: | 1878-8750 |
| Popis: | An inflammatory response occurs after aneurysmal subarachnoid hemorrhage (aSAH) and predicts poor outcomes. Glucocorticoids suppress inflammation and promote fluid retention. Dexamethasone is often administered after aSAH for postoperative cerebral edema and refractory headache. Our objective was to examine the impact of dexamethasone use on functional outcomes and delayed cerebral ischemia (DCI) after aSAH.Patients with aSAH admitted between 2010 and 2015 were included; the data source was a single-center subarachnoid hemorrhage registry. The intervention of interest was a dexamethasone taper used7 days from ictus. The primary outcome was poor discharge functional outcome, with a modified Rankin Scale score3. Other outcomes included DCI and infection. A propensity score for use of dexamethasone was calculated using a logistic regression model that included potential predictors of dexamethasone use and outcome. The impact of dexamethasone on outcomes of interest was calculated and the propensity score was controlled for.A total of 440 patients with subarachnoid hemorrhage were admitted during the study period and 309 met eligibility criteria. Dexamethasone was administered in 101 patients (33%). A total of 127 patients (41%) had a discharge modified Rankin Scale score3, 105 (34%) developed DCI, and 94 (30%) developed an infection. After propensity score analysis, dexamethasone use was associated with a significant reduction in poor functional outcomes (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.19-0.66) but showed no significant association with DCI (OR, 0.93; 95% CI, 0.53-1.64) or infection (OR, 0.60; 95% CI, 0.34-1.06).Dexamethasone use after aSAH was associated with a reduction in poor functional outcomes at discharge but not DCI, controlling for predictors of dexamethasone use. |
| Databáze: | OpenAIRE |
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