Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage

Valery L Feigin; Neil Anderson; Gabriel JE Rinkel; Ale Algra; Jan van Gijn; Derrick A Bennett

doi:10.1002/14651858.CD004583.pub2

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Analysis 1.2

Comparison 1 Mineralocorticoid treatment versus control in SAH, Outcome 2 Poor outcome at the end of follow up.

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Analysis 1.3

Comparison 1 Mineralocorticoid treatment versus control in SAH, Outcome 3 Delayed cerebral ischaemia during the scheduled treatment or follow‐up period.

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Analysis 1.4

Comparison 1 Mineralocorticoid treatment versus control in SAH, Outcome 4 Adverse effects of the treatment.

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Analysis 2.1

Comparison 2 Glucocorticoid treatment versus control in SAH, Outcome 1 Death at the end of follow up.

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Analysis 2.2

Comparison 2 Glucocorticoid treatment versus control in SAH, Outcome 2 Poor outcome at the end of follow up.

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Analysis 2.4

Comparison 2 Glucocorticoid treatment versus control in SAH, Outcome 4 Adverse effects of the treatment.

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Analysis 3.1

Comparison 3 Corticosteroid treatment versus control in SAH, Outcome 1 Death at the end of follow up.

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Analysis 3.2

Comparison 3 Corticosteroid treatment versus control in SAH, Outcome 2 Poor outcome at the end of follow up.

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Analysis 3.3

Comparison 3 Corticosteroid treatment versus control in SAH, Outcome 3 Delayed cerebral ischaemia during the scheduled treatment or follow‐up period.

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Analysis 3.4

Comparison 3 Corticosteroid treatment versus control in SAH, Outcome 4 Adverse effects of the treatment.

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Analysis 4.1

Comparison 4 Glucocorticoid treatment versus control in PICH, Outcome 1 Death at the end of follow up.

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Analysis 4.2

Comparison 4 Glucocorticoid treatment versus control in PICH, Outcome 2 Poor outcome at the end of follow up.

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Analysis 4.3

Comparison 4 Glucocorticoid treatment versus control in PICH, Outcome 3 Adverse effects of the treatment.

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Comparison 1. Mineralocorticoid treatment versus control in SAH

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death at the end of follow up	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.1 At one month	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 At six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Poor outcome at the end of follow up Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.03, 3.20]

2.1 At one month	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 At six months	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.03, 3.20]
3 Delayed cerebral ischaemia during the scheduled treatment or follow‐up period Show forest plot	2	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.33, 1.27]

4 Adverse effects of the treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 Hypokalemia	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Hyperglycemia	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Any infection	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Exacerbation of diabetes mellitus	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.5 Blood pressure changes	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.6 Gastrointestinal bleeding	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.7 Other	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Mineralocorticoid treatment versus control in SAH

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Comparison 2. Glucocorticoid treatment versus control in SAH

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death at the end of follow up Show forest plot	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.85, 2.61]

1.1 At one month	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.85, 2.61]
1.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 At six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Poor outcome at the end of follow up Show forest plot	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.80, 1.24]

2.1 At one month	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.80, 1.24]
2.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 At six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Delayed cerebral ischaemia during the scheduled treatment or follow‐up period	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Adverse effects of the treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 Hypokalemia	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Hyperglycemia	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Any infection	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Exacerbation of diabetes mellitus	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.5 Blood pressure changes	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.6 Gastrointestinal bleeding	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.7 Other	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Glucocorticoid treatment versus control in SAH

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Comparison 3. Corticosteroid treatment versus control in SAH

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death at the end of follow up Show forest plot	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.85, 2.61]

1.1 At one month	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.85, 2.61]
1.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 At six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Poor outcome at the end of follow up Show forest plot	2	165	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.77, 1.20]

2.1 At one month	1	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.80, 1.24]
2.2 After one to six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 At six months	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.03, 3.20]
3 Delayed cerebral ischaemia during the scheduled treatment or follow‐up period Show forest plot	1	91	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.35, 1.41]

4 Adverse effects of the treatment Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 Hypokalemia	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Hyperglycemia	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Any infection	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Exacerbation of diabetes mellitus	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.5 Blood pressure changes	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.6 Gastrointestinal bleeding	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.7 Other	2		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Corticosteroid treatment versus control in SAH

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Comparison 4. Glucocorticoid treatment versus control in PICH

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death at the end of follow up Show forest plot	5	206	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.87, 1.35]

1.1 At one month	4	186	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.91, 1.42]
1.2 At six months	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.19, 1.86]
2 Poor outcome at the end of follow up Show forest plot	3	146	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.83, 1.09]

2.1 At one month	3	146	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.83, 1.09]
2.2 At six months	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Adverse effects of the treatment Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3.1 Hypokalemia	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Hyperglycemia	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Any infection	3		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Exacerbation of diabetes mellitus	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.5 Blood pressure changes	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.6 Gastrointestinal bleeding	3		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.7 Other	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Glucocorticoid treatment versus control in PICH

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