Abstract 075: Associations between Glucocorticoid Treatment with Clinical Outcomes and Medical Complications in Patients with Subarachnoid Hemorrhage

Introduction and Purpose The impact of glucocorticoids (GCs) on outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is insufficiently explored. This study examined associations between GC treatment within one week from aSAH and clinical outcomes. Methods Retrospective, observational cohort study of adult patients with aSAH admitted to a comprehensive stroke center between 01/2014‐01/2019. Patients were stratified into two groups: GCs exposure within the first 7‐days from admission versus no GCs during the hospitalization. Propensity matched cohorts adjusted for age, gender, and Hunt‐&‐Hess grade on admission were compared using multivariable regressions to determine associations between GCs treatment and clinical outcomes of: discharge‐to‐home rates, severe vasospasm (defined as Lindegaard ratio > 6.0 on transcranial doppler), delayed cerebral ischemia (DCI, defined as cerebral infarction on magnetic resonance imaging), in‐hospital mortality and medical complications (ventriculostomy‐related infection, ventilator‐associated pneumonia, catheter‐associated urinary tract infection, delirium). Results Overall, 339 patients (mean age 54.7 ± 12.9) were included. Propensity matched cohort analysis was performed in 298 patients (mean age 54.4 ± 13.2). Most aneurysms (239, 80.2%) were located in the anterior circulation and 59 (19.8%) were in the posterior circulation; 152 (51%) underwent surgical clipping, 150 (50.3%) underwent endovascular coiling, and 4 underwent both procedures. Patients in the GCs group received a calculated median dose of dexamethasone of 114.7mg (IQR = 38‐295.6). Treatment with GCs was associated with higher discharge‐to‐home rates (z = 2.21, 95% confidence interval (CI) 0.28‐0.76), but also a higher frequency of severe vasospasm (z = 3.01, 95% CI 0.78‐1.56). A non‐significant trend towards lower frequency of DCI was noted in the GCs group (z = ‐1.8, 95% CI (‐0.68) ‐ (‐0.2)). No difference was found in all‐cause in‐hospital mortality or any of the medical complications between groups. Conclusion GCs treatment within the first 7‐days was associated with higher discharge‐to‐home rates, but mixed results were observed regarding the incidence of vasospasm and DCI. From a safety side‐effect profile, GCs appeared to be well tolerated. Our findings highlight the need for further studies to determine the utility of GCs in aSAH.