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

Akshitkumar M Mistry; Sumeeth V Jonathan; Meredith A Monsour; Bret C Mobley; Stephen W Clark; Paul L Moots

doi:10.1093/nop/npab039

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

Neurooncol Pract. 2021 Jun 23;8(5):589-600. doi: 10.1093/nop/npab039. eCollection 2021 Oct.

Authors

Akshitkumar M Mistry¹, Sumeeth V Jonathan², Meredith A Monsour², Bret C Mobley³, Stephen W Clark⁴, Paul L Moots⁴

Affiliations

¹ Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
² School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
³ Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Abstract

Background: We examined 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, Karnofsky performance status score, 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 16-mg increment (4 mg every 6 hours/day) of total dexamethasone associated with a 4% increase in mortality (95% confidence interval [CI] 1%-7%, P < .01), 12% increase in the odds of being prescribed dexamethasone from POD30 to POD90 (95% CI 6%-19%, P < .01), and 10% increase in the odds of being diagnosed with an infection (95% CI, 4%-17%, P < .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 1 month postoperatively.

Keywords: dexamethasone; glioblastoma; infection; steroids; survival.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.