Division of Infectious Diseases, UT Health Science Center At Houston, McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA.
Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
J Neurol. 2021 Jun;268(6):2151-2160. doi: 10.1007/s00415-021-10398-9. Epub 2021 Jan 21.
Adjuvant steroids have been used for the treatment of encephalitis, although there is limited data regarding its benefit. We described the use and impact of adjunctive steroids on adverse clinical outcomes (ACO) in adults with encephalitis.
Retrospective observational study of 230 adults with encephalitis at two tertiary care hospital systems in Houston, Texas, between August 2008 and September 2017. An ACO was assessed at the time of death or discharge and defined as a Glasgow Outcome Scale 1-4. A propensity score analysis was performed.
Out of 230 adult encephalitis patients enrolled, 121 (52.6%) received steroids. Adjunctive steroids were given more frequently to those who had focal neurological deficits (P = 0.01), required mechanical ventilation (MV) (P = 0.01), had intensive care unit admission (P < 0.001), had white matter abnormalities (P = 0.01) or cerebral edema on magnetic resonance imaging of the brain (P = 0.003). An ACO was seen in 135 (58.7%) of patients. The use of adjunctive steroids did not impact ACOs (P = 0.52) on univariate analyses or after propensity score matching. Predictors for an ACO in logistic regression analyses included a Glasgow Coma Score (GCS) < 8, fever, MV, and cerebral edema.
Adjunctive steroids are used more frequently in sicker patients and are not associated with improved clinical outcomes.
尽管关于辅助性类固醇治疗脑炎的疗效数据有限，但仍有研究将其用于脑炎的治疗。我们旨在描述辅助性类固醇在德克萨斯州休斯顿两家三级保健医院系统的 230 名成人脑炎患者中的使用情况及其对不良临床结局（ACO）的影响。
这是一项回顾性观察性研究，纳入了 2008 年 8 月至 2017 年 9 月期间在德克萨斯州休斯顿的两家三级保健医院系统的 230 名成人脑炎患者。在死亡或出院时评估 ACO，并将格拉斯哥结局量表 1-4 定义为 ACO。采用倾向评分分析。
在纳入的 230 名成人脑炎患者中，有 121 名（52.6%）接受了类固醇治疗。辅助性类固醇更常应用于有局灶性神经功能缺损（P=0.01）、需要机械通气（MV）（P=0.01）、入住重症监护病房（P<0.001）、有白质异常（P=0.01）或脑磁共振成像有脑水肿（P=0.003）的患者。135 名（58.7%）患者出现 ACO。在单变量分析或倾向评分匹配后，辅助性类固醇的使用均与 ACO 无关（P=0.52）。逻辑回归分析的 ACO 预测因素包括格拉斯哥昏迷评分（GCS）<8、发热、MV 和脑水肿。
辅助性类固醇在病情较重的患者中更常使用，但与改善的临床结局无关。
