Department of Neurology, Centre of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands.
Lancet Neurol. 2010 Mar;9(3):254-63. doi: 10.1016/S1474-4422(10)70023-5. Epub 2010 Feb 3.
Dexamethasone improves outcome for some patients with bacterial meningitis, but not others. We aimed to identify which patients are most likely to benefit from dexamethasone treatment.
We did a meta-analysis of individual patient data from the randomised, double-blind, placebo-controlled trials of dexamethasone for bacterial meningitis in patients of all ages for which raw data were available. The pre-determined outcome measures were death at the time of first follow-up, death or severe neurological sequelae at 1 month follow-up, death or any neurological sequelae at first follow-up, and death or severe bilateral hearing loss at first follow-up. Combined odds ratios (ORs) and tests for heterogeneity were calculated using conventional Mantel-Haenszel statistics. We also did exploratory analysis of hearing loss among survivors and other exploratory subgroup analyses by use of logistic regression.
Data from 2029 patients from five trials were included in the analysis (833 [41.0%] aged <15 years). HIV infection was confirmed or likely in 580 (28.6%) patients and bacterial meningitis was confirmed in 1639 (80.8%). Dexamethasone was not associated with a significant reduction in death (270 of 1019 [26.5%] on dexamethasone vs 275 of 1010 [27.2%] on placebo; OR 0.97, 95% CI 0.79-1.19), death or severe neurological sequelae or bilateral severe deafness (42.3%vs 44.3%; 0.92, 0.76-1.11), death or any neurological sequelae or any hearing loss (54.2%vs 57.4%; 0.89, 0.74-1.07), or death or severe bilateral hearing loss (36.4%vs 38.9%; 0.89, 0.73-1.69). However, dexamethasone seemed to reduce hearing loss among survivors (24.1%vs 29.5%; 0.77, 0.60-0.99, p=0.04). Dexamethasone had no effect in any of the prespecified subgroups, including specific causative organisms, pre-dexamethasone antibiotic treatment, HIV status, or age. Pooling of the mortality data with those of all other published trials did not significantly change the results.
Adjunctive dexamethasone in the treatment of acute bacterial meningitis does not seem to significantly reduce death or neurological disability. There were no significant treatment effects in any of the prespecified subgroups. The benefit of adjunctive dexamethasone for all or any subgroup of patients with bacterial meningitis thus remains unproven.
Wellcome Trust UK.
地塞米松可改善某些细菌性脑膜炎患者的预后，但对其他患者则不然。我们旨在确定哪些患者最有可能从地塞米松治疗中获益。
我们对所有年龄段的细菌性脑膜炎患者进行了地塞米松随机、双盲、安慰剂对照试验的个体患者数据进行了荟萃分析，这些试验提供了原始数据。预先确定的结局指标为首次随访时的死亡、1 个月随访时的死亡或严重神经后遗症、首次随访时的死亡或任何神经后遗症以及首次随访时的死亡或严重双侧听力损失。使用常规的 Mantel-Haenszel 统计数据计算合并比值比（OR）和异质性检验。我们还使用逻辑回归对幸存者中的听力损失和其他探索性亚组分析进行了探索性分析。
来自五项试验的 2029 名患者的数据纳入了分析（833 名[41.0%]年龄<15 岁）。580 名（28.6%）患者确诊或可能患有 HIV 感染，1639 名（80.8%）患者确诊为细菌性脑膜炎。地塞米松治疗并未显著降低死亡率（地塞米松组 1019 名患者中有 270 例[26.5%]，安慰剂组 1010 名患者中有 275 例[27.2%]；OR 0.97，95%CI 0.79-1.19），也未降低死亡或严重神经后遗症或双侧严重耳聋（地塞米松组 42.3%，安慰剂组 44.3%；0.92，0.76-1.11）、死亡或任何神经后遗症或任何听力损失（地塞米松组 54.2%，安慰剂组 57.4%；0.89，0.74-1.07）或死亡或严重双侧听力损失（地塞米松组 36.4%，安慰剂组 38.9%；0.89，0.73-1.69）。然而，地塞米松似乎可以降低幸存者的听力损失（地塞米松组 24.1%，安慰剂组 29.5%；0.77，0.60-0.99，p=0.04）。在所有其他预先指定的亚组中，包括特定的病原体、地塞米松治疗前的抗生素治疗、HIV 状态或年龄，地塞米松均无效果。将死亡率数据与所有其他已发表试验的数据进行汇总，并未显著改变结果。
细菌性脑膜炎的辅助性地塞米松治疗似乎不会显著降低死亡率或神经功能障碍。在所有预先指定的亚组中均未观察到显著的治疗效果。因此，地塞米松对所有细菌性脑膜炎患者或任何亚组患者的益处仍未得到证实。
英国惠康信托基金会。
Zotero 插件
