Impact of postoperative dexamethasone on survival, steroid dependency, and infections in newly diagnosed glioblastoma patients

Abstract

Background We examine the effect of dexamethasone prescribed in the initial 3 postoperative weeks on survival, steroid dependency, and infection in glioblastoma patients. Methods In this single-center retrospective cohort analysis, we electronically retrieved inpatient administration and outpatient prescriptions of dexamethasone and laboratory values from the medical record of 360 glioblastoma patients. We correlated total dexamethasone prescribed from postoperative day (POD) 0 to 21 with survival, dexamethasone prescription from POD30 to POD90, and diagnosis of an infection by POD90. These analyses were adjusted for age, KPS, tumor volume, extent of resection, IDH1/2 tumor mutation, tumor MGMT promoter methylation, temozolomide and radiotherapy initiation, and maximum blood glucose level. Results Patients were prescribed a median of 159 mg [109-190] of dexamethasone cumulatively by POD21. Every 16mg increment (4mg every 6 hours/day) of total dexamethasone associated with a 4% increase in mortality (95% confidence interval, CI, 1–7%, P<0.01), 12% increase in the odds of being prescribed dexamethasone from POD30-POD90 (95% CI 6–19%, P<0.01), and a 10% increase in the odds of being diagnosed with an infection (95% CI, 4–17%, P<0.01). Of the 175 patients who had their absolute lymphocyte count measured in the preoperative week, 80 (45.7%) had a value indicative of lymphopenia. In the POD1-POD28 period, this proportion was 82/167 (49.1%). Conclusions Lower survival, steroid dependency, and higher infection rate in glioblastoma patients associated with higher dexamethasone administration in the initial 3 postoperative weeks. Nearly half of the glioblastoma patients are lymphopenic preoperatively and up to one month postoperatively.

Impact of Perioperative Dexamethasone in the Context of Neurosurgical Brain Metastasis Resection

“…Additionally, upon stratification into subgroups of dexamethasone intake (cumulative pre-operative, postoperative and perioperative (total) dexamethasone intake), we only observed total dexamethasone to be associated with OS. Interestingly, there was no significant correlation between cumulative dexamethasone dose and tumor volume or edema volume ( eFigure 2a in the supplements ), which is in contrast to the observation from Zhou and colleagues for glioblastoma 17 . Limitations of this study include the retrospective nature of the data originating from a retrospective and prospective brain metastasis registry.…”

“…Here, the sum of cumulative dexamethasone doses in the pre-operative and post-operative period seems to have impact on OS as reported previously. For instance, Zhou et al demonstrated in a single-center PSM study that postoperative day (POD) 0 to 21 dexamethasone dosage correlated with overall survival 17 . Interestingly, Medikonda et al recently showed that that pre-operative, but not post-operative or pre- and postoperative Dexamethasone dosage in Glioblastoma patients was linked to shorter OS and reported a hazard ratio of 3.0 (95% CI: 0.9-9.4).…”

Proton pump inhibitors are detrimental to overall survival of patients with glioblastoma multiforme: results from a nationwide real-world evidence database

“…48 Other deleterious effects of dexamethasone on infection risk, lymphopenia, metabolic disturbances, thromboembolism risk, muscle wasting, and diminished performance status may also contribute to diminished survival. 49,50 Nevertheless, in this cohort of patients, the deleterious impact of corticosteroid use by multivariate analysis was less than half of the impact of PPI use.…”

Dexamethasone in Patients with Glioblastoma: A Systematic Review and Meta-Analysis

“…After screening all the abstracts, 153 studies were retrieved for full review. After the exclusion of ineligible studies, 22 studies were identified for the quantitative review [17,18,20,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (Figure 1).…”