Dexamethasone and clinical outcomes in malignant intestinal obstruction: A retrospective cohort study

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Payud Manprasert
Jiratha Budkaew
Bandit Chumworathayi

Abstract

The benefit of glucocorticoids is still inconclusive although many guidelines recommend using glucocorticoids in malignant intestinal obstruction. This study aimed to identify the efficacy of dexamethasone for clinical outcomes in malignant intestinal obstruction in a tertiary care hospital by retrospective cohort study. One hundred and forty-two patients were admitted for malignant intestinal obstruction, from January 2013 to July 2018, diagnosed by signs and symptoms, confirmed by radiologic imaging, and consequently investigated. The primary outcome was the change of vomiting at day four while the secondary outcome focused on the change of other clinical events at day four. Mean changes, 95% CIs, and comparison tests, were used to analyze. Dexamethasone users’ group was found to be associated with a higher mean change number of vomiting at day four [-3.0 (-4.3, -1.6) vs -1.0 (-1.3, -0.6), p<0.05] and a higher mean change of pain scores at day four [-5.4 (-6.2, -4.5) vs -1.8 (-2.3, -1.2), p<0.05]. Moreover, dexamethasone users’ group was proven to have a higher proportion of improved vomiting (80.8% vs 33.9%, p<0.05), a higher proportion of improved ability to pass stool (88.5% vs 35.7%, p<0.05), a higher proportion of improved abdominal pain at day four (96.2% vs 61.8%, p<0.05). In patients with malignant intestinal obstruction, dexamethasone was found to be associated with a higher mean change number of vomiting at day four, and a higher proportion of improved clinical outcomes at day four. Our investigation established the possible benefits of dexamethasone in malignant intestinal obstruction.

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