Association of dexamethasone with outcomes in aneurysmal subarachnoid hemorrhage: A Propensity-Matched analysis from...

The role of dexamethasone in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. The response to dexamethasone may vary depending on the management strategies between endovascular treatment and microsurgical clipping. We used the TriNetX database, a global network of healthcare organizations, to identify patients with aSAH. Patients were grouped based on whether they received endovascular treatment or microsurgical clipping. In each group, outcomes were analyzed based on dexamethasone usage. Odds ratios (ORs) for each outcome were calculated through propensity score-matched analysis. There were 11,078 patients in the endovascular group and 3,885 patients in the microsurgical clipping group. Dexamethasone use was associated with improved survival in patients who received endovascular treatment in both short- and mid-term outcomes (OR 0.35, 95% confidence interval (CI) 0.26-0.46 at 30 days; OR 0.42, 95% CI 0.33-0.53 at 6 months). However, no survival advantage was observed in patients who underwent microsurgical clipping. There were no significant differences in vasospasm or shunt requirements between patients who received dexamethasone and those who did not, irrespective of treatment type; however, patients who received dexamethasone had a lower rate of fever in both groups. aSAH is a challenging disease, and our study indicates that dexamethasone is associated with improved overall survival in patients who underwent endovascular treatment. Reconsidering the role of dexamethasone, with attention to treatment modality, may provide new insights and potentially different outcomes in aSAH management.