gms | German Medical Science

Objective: Treatment of patients suffering from non-traumatic subarachnoidal hemorrhage (SAH) remains challenging. Given that inflammation seems to play a key role in the etiology of vasospasms, the concept of suppression of inflammation by glucocorticoids appears promising. However, data undermining this notion is scarce except for the proven benefits of hydrocortisone to counteract deleterious hyponatremia, neither positive nor negative effects are clearly proven. Therefore, we conducted a study to evaluate benefits and side-effects of corticosteroids as part of a treatment algorithm for patients with SAH.

Methods: We performed a retrospective single center study analyzing electronic patient charts treated at our university hospital for non-traumatic SAH between May 2001 and November 2011. Diagnostics and therapy were done following international recommendations and according to clinical needs. Prior to 2009, patients were treated without Dexamethasone (Dexa); since 2009 Dexa (3 x 4 mg daily for 7 days) was part of our standard operating procedure. We investigated the impact of Dexa on patient’s outcome parameters such as hospital mortality, length of hospital stay (LOS) and on intensive care unit (ICU), daily Simplified Acute Physiology Score (SAPS 2), Glasgow Coma Score (GCS) upon admission and discharge, and possible infectiological complications.

Results: Clinical data of 379 patients with non-traumatic SAH were analyzed. Despite in in the all over population only a trend for a better survival was seen (p=0.068), data show a significant better survival rate in patients with severe SAH (WFNS III and IV) when patients were treated with dexamethasone (p=0.003) This survival benefit was seen in coiled, clipped, and non-interventional treated patients. Median leucocyte counts was significantly higher in the Dexa group. Median CRP - as a marker of inflammation - in the first 2 days of ICU stay as well as the median CRP in the first 7 days were significantly lower in patients with a favorable neurologic outcome (GCS 13-15 at discharge) in both groups. Median procalcitonin - as a marker of infection - did not differ significantly between groups. Despite equal blood-glucose control algorithms in both groups, there was higher incidence of hyperglycemia in the Dexa group.

Conclusion: In our retrospective single-center cohort study, despite evident side effects Dexa, appears to have positive effects with respect to mortality and neurological outcome as a part of a multimodal therapy for patients with non-traumatic SAH.