Abstract P434: Sex Differences in Outcomes After Subarachnoid Hemorrhage: Insight From the Subarachnoid Hemorrhage International Trialists Repository

Abstract

Introduction: Sex is a known predictor of outcome after acute ischemic stroke. However, the effect of sex on outcome after subarachnoid hemorrhage (SAH) is not well studied. Methods: Five studies from the SAH International Trialists repository were included (4 randomized trials and 1 prospective study). Patients were divided into groups based on sex. The primary outcome was favorable outcome which was defined as Glasgow Outcome Score (GOS) of 4 or 5 and the secondary outcome was delayed cerebral ischemia (DCI). Binary logistic regression was done to assess the association between sex and outcomes. Results: A total of 8015 patients (2186 males and 5829 females) were included. Female patients were older (mean age 53 vs 50 years, p<0.001) and had more severe neurological deficit on presentation (median World Federation of Neurosurgical Societies [WFNS] grade 2 vs.1; p<0.001). Favorable outcome was achieved less frequently in females in univariate analysis (51% vs. 62%; p<0.001). In a multivariable model adjusted for age, WFNS, Fisher score, aneurysm location, and aneurysm size, female was associated with lower odds of favorable outcome (OR= 0.82; 95% CI:0.73-0.92). DCI occurred more frequently in females (25% vs. 18%; p<0.001). In addition, women had higher risk of DCI after adjusting for potential confounders (women vs. men, OR 1.43; 95%CI: 1.26-1.63). We did not find an interaction between age and sex for both favorable outcome and clinical vasospasm. Conclusion: Female patients had worse functional outcome and higher risk of DCI after subarachnoid hemorrhage when compared to men.

Sex-related differences of invasive therapy in patients with aneurysmal subarachnoid hemorrhage

“…In the multivariate analysis, increasing age is independently associated with unfavorable outcome. Furthermore, female sex per se was a predictor of unfavorable outcome if including death as a possible outcome, confirming the recent preliminary data from a large cohort (n > 8000 patients) of aSAH patients [2]. This finding is quite interesting and it might also be secondary to the treatment targets that we set without taking into account patients' sex.…”

Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

“…In addition, several pooled cohort analyses have shown female sex to be associated with higher risk of DCI compared with males following SAH. 64,70 In contrast to the above findings, other single-institution investigations have failed to reveal a significant association between sex and vasospasm risk after SAH. 71,72 One literature review of risk factors for cerebral vasospasm following SAH found that most studies included in their analysis reported no correlation between sex and increased vasospasm risk.…”

“…63 Although the preponderance of data suggests no significant impact of sex on functional status following SAH, recent preliminary data from a large cohort (n>8000 patients) in the SAH international trialists repository found female sex to correlate with worse functional outcome (Glasgow Outcome Scale score 4-5). 64 Vasospasm/Delayed Cerebral Ischemia Following SAH Sex-based risk of vasospasm and delayed cerebral ischemia (DCI) after SAH, which can cause major morbidity and mortality, has been reported. One recent study queried the Nationwide Readmissions Database to identify adults who underwent clipping or coiling for aneurysmal SAH (n=8346) and found that female sex was a predictor for vasospasm in multivariable analysis (OR, 1.28 [95% CI, 1.05-1.56]).…”

“…63 Although the preponderance of data suggests no significant impact of sex on functional status following SAH, recent preliminary data from a large cohort (n>8000 patients) in the SAH international trialists repository found female sex to correlate with worse functional outcome (Glasgow Outcome Scale score 4–5). 64…”

“…In addition, several pooled cohort analyses have shown female sex to be associated with higher risk of DCI compared with males following SAH. 64,70…”