Alatawi Yasser, Alraddadi Eman A, Alhifany Abdullah A, Alzahrani Faisal E, Alknawy Saud M, Aljohani Nawaf M, Kecheck Husun K, Alaslab Alanoud K, Alamri Aser F, Aljabri Ahmed, Almarghalani Daniyah A, Alamri Faisal F
Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.
Department of Basic Sciences, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Front Pharmacol. 2025 Jun 17;16:1615170. doi: 10.3389/fphar.2025.1615170. eCollection 2025.
Stroke is a leading cause of morbidity and mortality worldwide, and its recurrence poses significant challenges to patient management and healthcare systems. This hospital-based retrospective observational study investigated the association between prior exposure to systemic corticosteroids and stroke recurrence within the Saudi Arabian population.
A multicenter retrospective study included acute-subacute adult ischemic stroke patients. Propensity score matching (PSM) was applied to balance baseline characteristics between the steroid and non-steroid groups. The primary outcome was the incidence of stroke recurrence within 365 days of the index stroke. Secondary outcomes included stroke severity and functional independence on admission and discharge, hemorrhagic transformation within 30 days, and mortality rate within 365 days of the index stroke.
Out of 925 patients, 85 (9.19%) received steroids. After PSM, the analysis included 254 patients, with 33.46% in the steroid group and 66.54% in the control group. Steroid-exposed patients had significantly lower National Institutes of Health Stroke Scale (NIHSS) scores at both admission (median 5 [interquartile range (IQR): 1-8] vs 6 [IQR: 3-10], = 0.0087) and discharge (median 1 [IQR: 0-4.5] vs 4 [IQR: 2-9], = 0.0001), but higher modified Rankin Scale (mRS) scores at discharge (median 5 [IQR: 4-5] vs 4 [IQR: 3-5], = 0.0004). Univariate analysis revealed significant associations between steroid exposure and a reduced likelihood of aphasia (OR: 0.33, 95% CI: 0.17-0.67, = 0.0020) and dysarthria (OR: 0.51, 95% CI: 0.30-0.88, = 0.0149). Conversely, steroid exposure was linked to increased risks of pneumonia (OR: 2.08, 95% CI: 1.22-3.55, = 0.0071), deep vein thrombosis-pulmonary embolism (DVT-PE) (OR: 2.70, 95% CI: 1.30-5.62, = 0.0079), and impaired consciousness (OR: 1.80, 95% CI: 1.06-3.04, = 0.0303). In the multivariate analysis, steroid exposure was associated with an increased risk of stroke recurrence (OR: 1.98, 95% CI: 1.01-3.87, = 0.0471). However, this association did not retain significance after adjusting for confounders (OR: 1.14, 95% CI: 0.44-2.96, p = 0.7874).
The study revealed that steroids were associated with significantly lower stroke severity but higher mRS scores. However, the risk of stroke recurrence was similar between the two groups. Moreover, the use of steroids may increase the risk of complications in stroke patients, such as pneumonia and DVT-PE. Future studies with larger sample sizes and more detailed data on steroid use and stroke outcomes are required. These studies would provide more definitive insights and guide clinical decision-making regarding the use of steroids in stroke management.
中风是全球发病和死亡的主要原因，其复发给患者管理和医疗系统带来了重大挑战。这项基于医院的回顾性观察研究调查了沙特阿拉伯人群中既往全身性皮质类固醇暴露与中风复发之间的关联。
一项多中心回顾性研究纳入了急性-亚急性成年缺血性中风患者。应用倾向评分匹配（PSM）来平衡类固醇组和非类固醇组之间的基线特征。主要结局是首次中风后365天内中风复发的发生率。次要结局包括入院和出院时的中风严重程度和功能独立性、30天内的出血性转化以及首次中风后365天内的死亡率。
在925例患者中，85例（9.19%）接受了类固醇治疗。PSM后，分析纳入了254例患者，类固醇组占33.46%，对照组占66.54%。接受类固醇治疗的患者在入院时（中位数5[四分位间距（IQR）：1 - 8]对6[IQR：3 - 10]，P = 0.0087）和出院时（中位数1[IQR：0 - 4.5]对4[IQR：2 - 9]，P = 0.0001）的美国国立卫生研究院卒中量表（NIHSS）评分显著较低，但出院时改良Rankin量表（mRS）评分较高（中位数5[IQR：4 - 5]对4[IQR：3 - 5]，P = 0.0004）。单因素分析显示，类固醇暴露与失语可能性降低（OR：0.33，95%CI：0.17 - 0.67，P = 0.0020）和构音障碍（OR：0.51，95%CI：0.30 - 0.88，P = 0.0149）之间存在显著关联。相反，类固醇暴露与肺炎风险增加（OR：2.08，95%CI：1.22 - 3.55，P = 0.0071）、深静脉血栓形成-肺栓塞（DVT-PE）（OR：2.70，95%CI：1.30 - 5.62，P = 0.0079）和意识障碍（OR：1.80，95%CI：1.06 - 3.04，P = 0.0303）相关。在多因素分析中，类固醇暴露与中风复发风险增加相关（OR：1.98，95%CI：1.01 - 3.87，P = 0.0471）。然而，在调整混杂因素后，这种关联不再具有统计学意义（OR：1.14，95%CI：0.44 - 2.96，P = 0.7874）。
该研究表明，类固醇与显著较低的中风严重程度相关，但mRS评分较高。然而，两组之间中风复发的风险相似。此外，使用类固醇可能会增加中风患者并发症的风险，如肺炎和DVT-PE。需要进行样本量更大、关于类固醇使用和中风结局数据更详细的未来研究。这些研究将提供更明确的见解，并指导中风管理中类固醇使用的临床决策。
