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.
Bibliographical noteFunding Information:
sity Medical Center Groningen, the Netherlands; Nima Etminan: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Daniel Hanggi: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; David Hasan: The Roy J. and Lucille A. Carver School of Medicine, University of Iowa, Iowa City, Iowa; S. Claiborne Johnston: Dell Medical School, University of Texas, Austin, Texas; Peter Kirkpatrick: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Peter Le Roux: MLHC Brain & Spine Center at Lanke-nau Medical Center, Wynnewood, Pennsylvania; Stephan Mayer: Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Andrew Molyneux: The Manor Hospital, Oxford, United Kingdom; Adam Noble: Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool, United Kingdom; John Pickard: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Audrey Quinn: The General Infirmary, Leeds, United Kingdom; Karl Schaller: Service of Neurosurgery, University Hospital of Geneva, Switzerland; Thomas Schenk: Department of Neurology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Tom Schweizer: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada; Julian Spears: Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada; Michael Todd: Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa; James Torner: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa; Ming-Yuan Tseng: Medicines and Healthcare Products Regulatory Agency, University of Cambridge, United Kingdom; Mervyn Vergouwen: Department of Neurology, University Medical Center Utrecht, the Netherlands; and George Wong: Department of Surgery, Chinese University of Hong Kong, China.
Therapeutics Inc., is a consultant for Actelion Pharmaceuticals, Ltd., has direct stock ownership in Edge Therapeutics, receives non–study-related clinical/research support, and has ownership in the Heart and Stroke Foundation of Canada and the Brain Aneurysm Foundation.
© AANS 2018.
- Brain ischemia
- Cohort study
- Delayed cerebral ischemia
- Risk factor in epidemiology
- Subarachnoid hemorrhage
- Vascular disorders