Sex-Related Differences in Patients’ Characteristics, Provided Care, and Outcomes Following Spontaneous Intracerebral Hemorrhage

Wang, Sophie Shih-Yüng; Bögli, Stefan Yu; Nierobisch, Nathalie; Wildbolz, Stella; Keller, Emanuela; Brandi, Giovanna

doi:10.1007/s12028-022-01453-y

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…Similarly, our group recently reported that at our institution women with spontaneous intracerebral hemorrhage are less likely than men to receive an EVD despite comparable frequency of hydrocephalus/ventriculomegaly. Multivariate analysis proved male gender to be independently associated with EVD insertion in these patients even after correction for location and severity of bleeding [33].…”

Section: Discussionmentioning

confidence: 90%

“…We previously reported that male patients with spontaneous intracerebral hemorrhage were almost three times as likely to receive an external ventricular drain (EVD) in comparison to women in the absence of radiographic or clinical differences. We suggested that a form of "gender-bias" might have influenced the decisionmaking process for the insertion of an EVD [33] The identification of sex-and gender-related differences in patients with aSAH is of great interest to evaluate the current monitoring and treatment strategies in order to offer a more personalized management and to better distribute the available resources. The aim of this study was to compare clinical characteristics, management, intensity of treatment, and outcome among males and females with aSAH.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background Sex-related differences in patients with aneurysmal subarachnoid hemorrhage (aSAH) exist. More females than males are affected. Aneurysm location is associated to sex. The relationship between sex and outcome, however, is unclear. Possible differences in management might influence the occurrence of primary and secondary brain injury and thus outcome. The study compares demographics, intensity of treatment, complications, and outcome among females and males with aSAH. Methods All consecutive patients with aSAH admitted to the neurocritical care unit, University Hospital Zurich over a 5-year period were eligible in this retrospective study. Patients’ characteristics, comorbidities, aSAH severity, frequency of vasospasm/delayed cerebral ischemia, frequency of invasive interventions, and 3-month outcome were compared by sex. Univariate analysis was performed with the data dichotomized by sex, and outcome. Multivariate analysis for prediction of outcomes was performed. Results Three hundred forty-eight patients were enrolled (64% females). Women were older than men. Comorbidities, scores at admission, and treatment modality were comparable among males and females. Vasospasm and DCI occurred similarly among females and males. Interventions and frequency of intraarterial spasmolysis were comparable between sexes. In the multivariate analysis, increasing age, female sex, increasing comorbidities, WFNS and Fisher grade, and presence of delayed cerebral ischemia were predictors of unfavorable outcome when considering all patients. However, after excluding death as a possible outcome, sex did not remain a predictor of unfavorable outcome. Conclusions In the study population, women with aSAH might have present a worse outcome at 3 months. However, no differences by sex that might explain this difference were found in intensity of treatment and management.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Women in the FAST cohort were older than men and had a higher prevalence of premorbid hypertension (both statistically not significant) which might correlate with higher baseline comorbidities in women not recorded in the FAST trial. Women may have received less aggressive care 37 , or may have had a higher incidence of in-hospital complications. 37 38 Given that an age-dependent increased risk of poor outcomes in women has been reported, the overall younger age of the FAST participants compared to prior cohorts may explain discrepancies with prior studies as well.…”

Section: Discussionmentioning

confidence: 99%

“…Women may have received less aggressive care 37 , or may have had a higher incidence of in-hospital complications. 37 38 Given that an age-dependent increased risk of poor outcomes in women has been reported, the overall younger age of the FAST participants compared to prior cohorts may explain discrepancies with prior studies as well. 39…”

Section: Discussionmentioning

confidence: 99%

Sex differences in perihematomal edema volume and outcome after intracerebral hemorrhage

Witsch,

Cao,

Song

et al. 2023

Preprint

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ObjectiveTo determine whether in patients with intracerebral hemorrhage (ICH) perihematomal edema (PHE) volume trajectories differ by sex.MethodsWe conducted a post-hoc analysis of the Factor-VII-for-Acute-Hemorrhagic-Stroke-Treatment (FAST) trial that randomized patients with ICH to receive recombinant activated Factor VIIa or placebo. Computerized planimetry calculated PHE and ICH volumes on serial CT scans (at baseline [within 3 hours of onset], at 24, and at 72 hours). Generalized estimating equations examined interactions between sex, CT-timepoints, and FAST treatment-arm on PHE and ICH volumes. Mixed and multivariate logistic models examined associations between sex, PHE, and outcomes.Results781 with supratentorial ICH (mean age 65 years) were included. Compared to women (n=296), men (n=485) had similar median ICH (14.9 versus 13.6 ml, p=0.053), and PHE volumes (11.1 versus 10.5 ml, p=0.56) at baseline but larger ICH and PHE at 24 hours (19.0 versus 14.0, p<0.001; 22.2 versus 15.7, p<0.001) and 72 hours (16.0 versus 11.8, p<0.001; 28.7 versus 19.9, p<0.001). Men had higher absolute PHE expansion (p<0.001), and more hematoma expansion (growth ≥33% or 6 mL at 24 hours, 33% versus 22%, p<0.001). An interaction between sex and CT-timepoints on PHE (p<0.001) but not on ICH volumes confirmed a steeper PHE trajectory in men. PHE expansion (per 5mL, odds radio, 1.19, 95%-confidence interval 1.10-1.28), but not sex, was associated with poor outcome.ConclusionsPHE expansion and trajectory in men were significantly higher. PHE expansion was associated with poor outcomes independent of sex. Mechanisms leading to sex differences in PHE trajectories merit further investigation.What is already known on this topicPrior research has reported sex differences in intracerebral hemorrhage (ICH) characteristics and some studies suggest worse outcome after ICH in women. However, we do not have a good understanding whether there are sex differences in perihematomal edema (PHE) volume trajectories, or whether sex, independent of confounders, is associated with poor after ICH.What this study adds:In this post-hoc analysis of 781 patients with supratentorial ICH from the Factor-VII-for-Acute-Hemorrhagic-Stroke-Treatment (FAST) trial in which patients underwent brain CT imaging time-locked to symptom onset (within 3 hours of symptom onset, at 24 hours, and at 72 hours), men compared to women had similar ICH and PHE volumes at baseline, but larger ICH expansion and PHE expansion on follow up imaging. The PHE but not the ICH volume trajectory across scans was significantly higher in men than in women. While PHE expansion was associated with poor outcome at 90 days, outcome between the sexes was similar at 90 days, and sex was not associated with outcome.How this study might affect research, practice or policy:The finding of heightened early PHE and ICH expansion in men may inform study design, patient recruitment strategies, and pre-specification of subgroup analyses in future interventional trials. The findings of this study also suggest that focusing on sex-specific factors may allow novel mechanistic insight into PHE, a major cause of secondary injury and poor outcome after ICH.

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“…Some of the known risk factors for hematoma expansion include symptom onset to initial CT imaging, higher initial ICH volumes, concurrent antiplatelet and anticoagulant usage, and the presence of contrast extravasation on CTA, also known as the "spot sign” [ 13 , 14 ]. Of note, ICH volume is the strongest predictor of 30-day mortality regardless of hematoma location.…”

Section: Discussionmentioning

confidence: 99%

Frontal Lobe Hemorrhage With Surrounding Edema and Subarachnoid Hemorrhage

Vu¹,

Mohamed²,

Stead³

et al. 2022

Cureus

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We report the case of an 81-year-old woman who presented with a left hemineglect, a rightward gaze preference, and baseline disorientation. Her National Institutes of Health Stroke Score was 4. Her medical history was significant for dementia, osteoporosis, dyslipidemia, and a previous stroke. CT revealed a rightsided frontal lobe hemorrhage with surrounding edema and subarachnoid hemorrhage. Laboratory evaluation was significant for leukocytosis. The etiologies, clinical presentation, and diagnosis of this often devastating type of stroke are presented. While she did have a significant neurologic deficit (neglect), she was able to remain alert and protect her airway. Her hospital course consisted of observation in the ICU and blood pressure management. The case illustrates that intracerebral hemorrhage (ICH) can sometimes present indolently and does not always require surgical intervention.

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Sex-Related Differences in Patients’ Characteristics, Provided Care, and Outcomes Following Spontaneous Intracerebral Hemorrhage

Cited by 16 publications

References 20 publications

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

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

Sex differences in perihematomal edema volume and outcome after intracerebral hemorrhage

Frontal Lobe Hemorrhage With Surrounding Edema and Subarachnoid Hemorrhage

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