title: Impact of dexamethasone in patients with aneurysmal subarachnoid haemorrhage.
abstract: The role of corticosteroids in the treatment of patients with aneurysmal subarachnoid haemorrhage (SAH) has remained controversial for decades. Recent studies have suggested that the administration of corticosteroids in SAH patients is associated with favourable outcomes. Given their significant adverse effects, it is essential to identify those patients who will benefit from treatment with corticosteroids.
  
  
  
  A retrospective analysis of a prospectively collected cohort (n = 306) with SAH who were treated by microsurgical clipping or endovascular intervention was performed. The role of dexamethasone administration was analysed with regard to clinical conditions and SAH-related complications. Outcome was assessed at discharge and during follow-up using the Glasgow Outcome Scale (GOS).
  
  
  
  Patients treated with dexamethasone presented with more episodes of hyperglycaemia (P < 0.001), more overall infections (P < 0.001) and more ventriculostomy-related infections (P = 0.004). Multivariate analysis demonstrated that treatment with dexamethasone was associated with an unfavourable outcome at discharge (GOS 1-3) [odds ratio (OR) 2.814, 95% confidence interval (CI) 1.440-5.497, P = 0.002]. In the subgroup of microsurgically treated patients, dexamethasone administration was associated with a favourable outcome at follow-up (OR 0.193, 95% CI 0.06-0.621, P = 0.006). A higher risk for unfavourable outcome (OR 3.382, 95% CI 1.67-6.849, P = 0.001) at discharge was observed in endovascularly treated patients who received dexamethasone but this had no impact on the outcome at follow-up.
  
  
  
  Treatment with dexamethasone seems to be associated with a risk reduction for an unfavourable outcome in those patients who underwent microsurgical clipping. Despite an increased frequency of adverse effects, glucocorticoids may have a potential benefit in this specific surgical subgroup compared to endovascularly treated SAH patients.
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Czorlich
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Sauvigny
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Ricklefs
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Abboud
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Nierhaus
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Anaesthesiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: D A
authors.initials: DA
authors.lastname: Reuter
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Regelsberger
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
authors.forename: N O
authors.initials: NO
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D023261:Glasgow Outcome Scale; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007239:Infections / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: blood glucose levels; clipping; dexamethasone; endovascular treatment; infection; outcome; subarachnoid haemorrhage