TY - JOUR
T1 - Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage
AU - SAHIT collaborators
AU - Germans, Menno R.
AU - Jaja, Blessing N.R.
AU - De Oliviera Manoel, Airton Leonardo
AU - Cohen, Ashley H.
AU - Macdonald, R. Loch
AU - Van Den Bergh, Walter
AU - Etminan, Nima
AU - Hanggi, Daniel
AU - Hasan, David
AU - Johnston, S. Claiborne
AU - Kirkpatrick, Peter
AU - Le Roux, Peter
AU - Mayer, Stephan
AU - Molyneux, Andrew
AU - Noble, Adam
AU - Pickard, John
AU - Quinn, Audrey
AU - Schaller, Karl
AU - Schenk, Thomas
AU - Schweizer, Tom
AU - Spears, Julian
AU - Todd, Michael
AU - Torner, James
AU - Tseng, Ming Yuan
AU - Vergouwen, Mervyn
AU - Wong, George
N1 - Publisher Copyright:
© AANS 2018.
PY - 2018/8
Y1 - 2018/8
N2 - OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.
AB - OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.
KW - Brain ischemia
KW - Cohort study
KW - Delayed cerebral ischemia
KW - Risk factor in epidemiology
KW - Sex
KW - Subarachnoid hemorrhage
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=85051192571&partnerID=8YFLogxK
U2 - 10.3171/2017.3.JNS162808
DO - 10.3171/2017.3.JNS162808
M3 - Article
C2 - 28862545
AN - SCOPUS:85051192571
SN - 0022-3085
VL - 129
SP - 458
EP - 464
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 2
ER -