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Steroids fail to prevent hydrocephalus in aneurysmal subarachnoid haemorrhage

10 Feb 2019

Steroids do not appear to be an effective prophylactic agent against incident hydrocephalus and subsequent ventriculoperitoneal shunt (VPS) in patients with aneurysmal subarachnoid haemorrhage (aSAH), according to a study.

Researchers looked at 288 patients with aSAH admitted to two tertiary care centres. They analysed the following data: age, sex, hypertension, Glasgow coma scale (GCS), Hunt Hess (HH) grade, administration of steroids (dexamethasone [DXM], methylprednisolone [MTP] or none), presence of hydrocephalus and VPS, as well as occurrence of adverse events such as hyperglycaemia, delirium and infection.

Mean age of the cohort was 56.9 years, with 64.6 percent of patients being female and 50.5 percent being hypertensive. Median GCS score was 14 (IQR, 7–15), while median HH grade was 3 (IQR, 2–4). A significant proportion of patients (71 percent) received DXM, 8 percent received MTP and the remaining 21 percent were not administered any steroids (controls) during hospital stay.

When outcomes were analysed, the incidence of hydrocephalus did not significantly differ across the patient groups, occurring in 56.4 percent of patients who received DXM vs 56.5 percent of those who received MTP vs 61.6 percent of no-steroid controls (p>0.05). Results were similar for incident VPS placement (p>0.05).

Conversely, receipt of steroids was associated with a greater likelihood of developing pneumonia (31 percent with DMX vs 31.8 percent with MTP vs 8.2 percent with nontreatment; p=0.008). Furthermore, patients who received DXM but not MTP were more frequently treated for a urinary tract infection (23.5 percent vs 9.8 percent with no treatment; p=0.019).

There was no difference in the incidence of hyperglycaemia or delirium across the patient groups.

The present data lend support to the evidence that, although commonly observed in clinical practice, administering steroids in patients with aSAH does not reduce the risk of developing hydrocephalus and subsequent VPS but may rather increase the risk of infections such as pneumonia and urinary tract infection.

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