Efficacy and safety of corticosteroids for stroke and traumatic brain injury: a systematic review and meta-analysis

作者：Yanan Wang, Linrui Huang, Jingjing Li, Jiangang Duan, Xiaohua Pan, Bijoy K. Menon, Craig S. Anderson, Ming Liu, Simiao Wu · 发表于：Systematic Reviews · 年份：2025 · DOI：10.1186/s13643-025-02803-5 · 被引用次数：15 · 研究领域：Adrenal Hormones and Disorders、Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery

Corticosteroids are frequently used in practice to treat patients with neurological disorders. However, its effect for stroke and traumatic brain injury (TBI) remains controversial. This study aimed to systematically review and evaluate efficacy and safety of corticosteroids for the treatment of stroke and TBI. We searched Ovid-Medline and Ovid-Embase databases for randomised controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of corticosteroids in patients with ischaemic stroke, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or TBI. The treatment intervention was corticosteroid, and the control was placebo or routine care. Outcome measures were death, functional outcomes and adverse events. We calculated odds ratio (OR) and 95% confidence interval (CI) for the effect size, pooled the results using random-effects modelling, and assessed heterogeneity by I 2 statistic. We identified 47 studies (41 RCTs and 6 cohort studies). Nine studies enrolled patients with ischaemic stroke ( n = 2806), 6 studies for ICH ( n = 1229), 1 study recruited both ischaemic stroke ( n = 13) and ICH ( n = 27), 10 studies for SAH ( n = 1318) and 21 studies for TBI ( n = 12,414). Dexamethasone was the most used corticosteroid (28 studies). Corticosteroids reduced risk of death at 3 months after ischaemic stroke ( n = 1791; 31% vs. 26%, OR 0.77, 95% CI 0.62–0.95; df = 1, I 2 = 0%) and after ICH (1 study; n = 850; 44% vs. 27%, OR 0.48, 95% CI 0.35–0.64), had n...