Adjunctive steroids in adults with encephalitis: a propensity score analysis

Abstract

Objective

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.

Methods

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.

Results

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.

Interpretation

Adjunctive steroids are used more frequently in sicker patients and are not associated with improved clinical outcomes.

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Acknowledgements

We want to thank Mr. and Mrs. Starr for their continued support of our research.

Funding

Grant A Starr Foundation.

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Correspondence to Rodrigo Hasbun.

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Conflicts of interest

RH is a speaker and has research support from Biofire®. All other authors do not have any conflicts of interest.

Ethical standard

This study was approved by the University of Texas Health Committee for the Protection of Human Subjects, the Memorial Hermann Hospital Research Review Committee, and the Harris Health Research Committee.

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Allana, A., Samannodi, M., Hansen, M.A. et al. Adjunctive steroids in adults with encephalitis: a propensity score analysis. J Neurol (2021). https://doi.org/10.1007/s00415-021-10398-9

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Keywords

  • Encephalitis
  • Adjunctive steroids
  • Outcomes
  • Adults