Abstract TP551: The Safety and Utility of Steroids in Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: Hydrocephalus is a common complication in patients with aneurysmal subarachnoid hemorrhage (aSAH) and is one of the predictors of poor outcome. Currently the only treatment modality for hydrocephalus is shunting; there is no known prophylactic therapy. Limited pre-clinical data suggest that anti-inflammatory effect of steroids could be used to prevent arachnoiditis and subarachnoid fibrosis after aSAH, which in turn may reduce the rate of hydrocephalus that requires shunting. Methods: A retrospective study of patients with aSAH admitted to two tertiary care centers from 2009 to 2017 was performed. Age, sex, hypertension, Glasgow coma scale [GCS], Hunt Hess [HH] grade, administration of steroids (dexamethasone [DXM], methylprednisolone [MTP] or none), presence of hydrocephalus and ventriculoperitoneal shunt (VPS) as well as occurrence of adverse events such as hyperglycemia, delirium and infection were recorded for each patient. Results: A total number of 288 patients were included. Mean age was 56.9±13.9 years, 186 (64.6%) patients were female and 145 (50.5%) patients had hypertension. Median GCS score was 14 (IQR 7-15) and median HH grade was 3 (IQR 2-4). 204 (71%) patients received DXM, 23 (8%) patients received MTP and 61 (21%) patients were not administered any steroids during hospital stay. Hydrocephalus was present in 114 (56.4%) patients who received DXM, 13 (56.5%) who received MTP and 37 (61.6%) who did not receive steroids (p>0.05; χ 2 -test). The incidence of VPS placement did not differ between the groups (p>0.05; χ 2 -test). Patients who received steroids were more likely to develop pneumonia (63 [31%] vs. 7 [31.8%] vs. 5 [8.2%] in DMX, MTP and no steroids group, respectively; p=0.008; χ 2 -test). Patients who received DXM (but not MTP) more frequently were treated for a urinary tract infection (48 [23.5%] vs. 6 [9.8%]; p=0.019; χ 2 -test). There was no difference in the ratio of hyperglycemia or delirium between the groups. Conclusion: Our results support the evidence that, although commonly used in clinical practice, steroids administered in patients with aSAH do not decrease the risk of developing hydrocephalus and subsequent VPS. In addition, steroids may increase the risk of infections such as pneumonia and urinary tract infection.