A comparison of acute hemorrhagic stroke outcomes in 2 populations: the Crete-Boston study.
OBJECTIVE
Although corticosteroid use in acute hemorrhagic stroke is not widely adopted, management with intravenous dexamethasone has been standard of care at the University Hospital of Heraklion, Crete with observed outcomes superior to those reported in the literature. To explore this further, we conducted a retrospective, multivariable-adjusted 2-center study.


METHODS
We studied 391 acute hemorrhagic stroke cases admitted to the University Hospital of Heraklion, Crete between January 1997 and July 2010 and compared them with 510 acute hemorrhagic stroke cases admitted to Massachusetts General Hospital, Boston, from January 2003 to September 2009. Of the Cretan cases, 340 received a tapering scheme of intravenous dexamethasone, starting with 16 to 32 mg/day, whereas the Boston patients were managed without steroids.


RESULTS
The 2 cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0%, n=510; P<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510; P<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359; P<0.001). The improved survival on Crete was observed 3 days after initiation of intravenous dexamethasone and was pronounced for deep-seated hemorrhages. After adjusting for acute hemorrhagic stroke volume/location, Glasgow Coma Scale, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet, and anticoagulant use, intravenous dexamethasone treatment was associated with better functional outcomes and significantly lower risk of death at 30 days (OR, 0.357; 95% CI, 0.174-0.732).


CONCLUSIONS
This study suggests that intravenous dexamethasone improves outcome in acute hemorrhagic stroke and supports a randomized clinical trial using this approach.
Neurology Department, University Hospital of Heraklion, Voutes, 71021, Heraklion, Crete, Greece.
Ioannis
I
Zaganas
Amy P
AP
Halpin
Alexandra
A
Oleinik
Athanasios
A
Alegakis
Dimitra
D
Kotzamani
Spiros
S
Zafiris
Chryssanthi
C
Chlapoutaki
Dimitris
D
Tsimoulis
Emmanouil
E
Giannakoudakis
Nikolaos
N
Chochlidakis
Aikaterini
A
Ntailiani
Christina
C
Valatsou
Efrosini
E
Papadaki
Antonios
A
Vakis
Karen L
KL
Furie
Steven M
SM
Greenberg
Andreas
A
Plaitakis
D000368:Aged; D001900:Boston; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006115:Greece; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
D005938:Glucocorticoids; D003907:Dexamethasone