Administration of dexamethasone and mortality in brain abscess patients: A Systematic Review and Meta-Analysis.

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Administration of dexamethasone and mortality in brain abscess patients: A Systematic Review and Meta-Analysis.

World Neurosurg. 2018 Apr 26;:

Authors: Simjian T, Muskens IS, Lamba N, Yunusa I, Wong K, Veronneau R, Kronenburg A, Brouwers HB, Smith TR, Mekary RA, Broekman MLD

Abstract
OBJECTIVE: Dexamethasone has been used to treat cerebral edema associated with brain abscesses. Whereas some argue that dexamethasone might aid the antibiotic treatment, others believe that because of its immune-suppressive characteristics, it might have a negative impact on outcomes. To date it is still unclear how corticosteroid use affects overall mortality of brain abscess patients.
METHODS: A systematic search of the literature was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were utilized to identify all studies related to patients diagnosed with a brain abscess treated with dexamethasone. The main outcome of interest was mortality. Pooled effect estimates were calculated using fixed-effect (FE) and random-effects (RE) models.
RESULTS: After removal of duplicates, 1681 articles were extracted from the literature of which 11 were included. These included 7 cohort studies and 4 case series. Indications to administer dexamethasone were either hospital brain abscess protocol or clinical presentation of cerebral edema. The seven cohort studies involving 571 patients with brain abscesses comprised of 330 patients treated with standard of care (SOC) plus dexamethasone and 241 patients treated with SOC alone, after aspiration or surgical management of the abscess in either group. Pooling results from all seven cohort studies demonstrated a non-significant mortality benefit comparing SOC and dexamethasone patients to SOC patients (RR= 0.94; 95% CI: 0.64-1.37, FE; RR=0.95; 95% CI: 049-1.82, RE; I2 = 53.9%; P-heterogeneity = 0.04).
CONCLUSION: In brain abscess patients treated with antibiotics, the use of dexamethasone was not associated with increased mortality.

PMID: 29705232 [PubMed - as supplied by publisher]

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