Female Gender Remains an Independent Risk Factor for Poor Outcome after Acute Nontraumatic Intracerebral Hemorrhage

Ganti, Latha; Jain, Anunaya; Yerragondu, N.; Jain, Minal; Bellolio, M. Fernanda; Gilmore, R.M.; Rabinstein, Alejandro A.

doi:10.1155/2013/219097

Cited by 56 publications

(44 citation statements)

References 32 publications

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“…Most of these data have been reported previously, including the higher ICH prevalence in men, 19 although this finding is not uniform in all studies. 4 In most of the previous reports, women with ICH were older than their male counterparts, 12,18,20 similar to the findings for ischemic stroke. 21 The higher tobacco and alcohol use we observed in men also has been described previously 22 and probably reflects behavioral and cultural sex differences rather than a sex-specific risk factor.…”

supporting

confidence: 78%

“…Some methodologic problems that would account for the inconsistencies and heterogeneity of the available data have been noted, such as differences in metrics used, length of study period, race/ethnicity of participants, etiology, or the adjustments made in the statistical analysis. [4][5][6] Moreover, most of the available data are from retrospective stroke registries [6][7][8][9][10][11][12] or from studies published more than a decade ago. 13,14 The most recent published series comes from Asian countries, 15,16 and probably have some bias and racial/ethnic specificity.…”

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confidence: 99%

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Sex-related differences in primary intracerebral hemorrhage

et al. 2016

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Objective: Little information is available about sex-related differences in intracerebral hemorrhage (ICH). This is a prospective observational study to describe the sex differences in demographics, vascular risk factors, stroke care, and outcomes in primary ICH.Methods: BasicMar is a hospital-based registry of all stroke patients admitted to a single public hospital that covers a population of 330,000. From 2005 to 2015, there were 515 consecutive acute primary ICH patients. Outcome data were obtained at 3 months.Results: More men than women had ICH (52.4% vs 47.6%); the women were older and had worse previous functional status than men, who were more likely to drink alcohol and smoke and to have ischemic heart disease and peripheral arterial disease. There were no sex differences in etiology, severity, or hemorrhage volume. ICH score was greater in women than in men (p 5 0.018). Women had more lobar ICH than men (odds ratio adjusted by age was 1.75 [95% confidence interval 1.18-2.58], p 5 0.005). The quality of stroke care was similar in both sexes. Mortality at 3 months was 44.1% in women and 41.1% in men (p 5 0.656), and 3-month poor outcome among survivors (modified Rankin Scale [mRS] score 3-5) 58.4% in women and 45.3% in men (p 5 0.027). After adjustment for previous mRS and ICH score, there were no differences in 3-month mortality or poor outcome at 3 months between sexes.Conclusions: Patients with ICH showed sex-related differences in demographic characteristics, ICH location, and vascular risk factors, but not in stroke care, 3-month mortality, or adjusted poor outcome. Neurology ® 2016;87:257-262 GLOSSARY CAA 5 cerebral amyloid angiopathy; CI 5 confidence interval; GCS 5 Glasgow Coma Scale; ICH 5 intracerebral hemorrhage; IQR 5 interquartile range; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Intracerebral hemorrhage (ICH) is the most severe stroke subtype, with about 50% mortality within the first month after the event and only about 20%-25% of survivors able to live independently at 6 months.1-4 Sex differences in ICH characteristics and outcome have not been fully studied and the reported results have been inconclusive. A meta-analysis in 2010 4 and a review published in 2015 5 both emphasize the conflicting results reported about sex differences in ICH outcomes. Both studies concluded that more data on functional outcome after ICH are needed. Some methodologic problems that would account for the inconsistencies and heterogeneity of the available data have been noted, such as differences in metrics used, length of study period, race/ethnicity of participants, etiology, or the adjustments made in the statistical analysis. [4][5][6] Moreover, most of the available data are from retrospective stroke registries [6][7][8][9][10][11][12] or from studies published more than a decade ago. 13,14 The most recent published series comes from Asian countries, 15,16 and probably have some bias and racial/ethnic specificity. Finally, it is not clear whether these series are exhau...

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confidence: 99%

Sex-related differences in primary intracerebral hemorrhage

et al. 2016

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“…11,[25][26][27] The results of our study concur with studies that found female sex to be predictive of ADL dependency after stroke. [27][28][29][30][31][32][33] In a systematic review by Gall et al, it was hypothesized that women may be more vulnerable than men to worse outcomes because of differences in demographic, social, and medical histories. 34 In the present study, women were ≈4 years older than men and a slightly higher proportion had atrial fibrillation.…”

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confidence: 99%

Changes in Functional Outcome Over the First Year After Stroke

Ullberg

Zia

Petersson

et al. 2015

Stroke

129

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Although recovery after stroke is usually regarded a phase of improvement until a plateau is reached, 13 deterioration in disability level may occur further on. The proportions of patients who do deteriorate, and their characteristics, have not been well delineated in any large recent studies.The aim of this study was to analyze case fatality and disability levels at 3 and 12 months, as well changes in functional outcome between 3 and 12 months, and predictors of dependency in activities of daily living (ADL), based on data from the Swedish Stroke Register. Methods MaterialsData were obtained from Riksstroke, the Swedish Stroke Register. 14 In Sweden, the proportion of stroke patients treated in hospital is estimated at 84%, 15 and in 2010, the estimated coverage rate of Riksstroke events was 88%. 16Background and Purpose-Large longitudinal studies on stroke outcome are scarce. The aim of this study was to analyze predictors and changes in functional outcome during the first year poststroke. Methods-Data on patients who were independent in activities of daily living (ADL) and hospitalized for acute stroke in 2008 to 2010 were obtained from the Swedish Stroke Register. Case fatality was assessed by linkage to the Swedish Population Register. ADL was defined by independence or dependence in dressing, toileting, and indoor mobility and assessed at 3 and 12 months. Predictors of ADL dependency were assessed through multivariate analysis. Results-In total, 64 746 patients were included. Case fatality at 3 months was 13.1% (men 11.6% versus women 14. . Conclusions-Transition from ADL independence to dependence was observed in a high proportion of patients between 3 and 12 months, challenging the common belief that functioning after stroke is stable beyond 3 months. Deterioration occurred more commonly in women, among whom 1/6 converted to dependency.

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“…Although there were limitations, several factors which were believed to affect the outcomes, i.e. age, 30 gender, 31 GCS on admission and volume of the hematomawere comparable in both groups. 32,33 In conclusion, a single dose of 100 mg tigecycline treatment before surgical procedure for hematoma evacuation of SSICH can significantly reduce TNF-α plasma level.…”

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confidence: 81%

Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

et al. 2016

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Hasil: Didapatkan perbedaan bermakna pada proporsi subjek yang mengalami penurunan kadar TNF-α pada kelompok tigesiklin dibanding fosfomisin pada hari ke-7 pascabedah (62% vs 29%, p=0,022). Pengurangan edema pacsa operasi berbeda tidak bermakna pada kedua kelompok (86% vs 80%, p=0,580). Tigesiklin menunjukkan efektivitas klinis mengurangi luaran buruk (GOS ≤ 2 (20% vs 38% ; p=0,096; OR=0,41; NNT=6) dan inhospital mortality ( 17% vs 35%; p=0,083; OR=0,49; NNT=5). LOS ≥ 15 hari ( 40% vs 27%; p=0,243;OR=1,81; NNT=8). Kesimpulan: Tigesiklin memiliki kemampuan antiinflamasi dan neuroproteksi, serta memperbaiki luaran klinis pada PISS yang dilakukan evakuasi hematoma. ABSTRACT Background:The outcome of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unsatisfactory. Inflammatory response secondary to brain injury as well as those resulted from surgical procedure were considered responsible of this outcome. This study was intended to elucidate the anti-inflammatory activity of tigecycline by measuring TNF-α level and its neuroprotective effect as represented by inhospital mortality rate. Methods:Patients with SSICH who were prepared for hematoma evacuation were randomized to receive either tigecycline (n=35) or fosfomycine (n=37) as prophylactic antibiotic. TNF-α level was measured in all subjects before surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was performed on postoperative day-7. The Glasgow outcome scale (GOS) and length of stay (LOS) were recorded at the time of hospital discharge. Data were analyzed using Mann-Whitney and Chi square test. Relative clinical effectiveness was measured by calculating the number needed to treat (NNT).Results: There was a significant difference regarding the proportion of subject who had reduced TNF-α level on postoperative day-7 between the groups receiving tigecycline and fosfomycine (62% vs 29%, p=0.022). Decrease brain edema on CT control (86% vs 80%, p=0.580). Tigecycline administration showed a tendency of better clinical effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49; NNT=5) and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41; NNT=6). LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8). Conclusion:Tigecycline showed anti-inflammatory and neuroprotective activities. These activities were associated with improved clinical outcome in patients with SSICH after hematoma evacuation.

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Female Gender Remains an Independent Risk Factor for Poor Outcome after Acute Nontraumatic Intracerebral Hemorrhage

Cited by 56 publications

References 32 publications

Sex-related differences in primary intracerebral hemorrhage

Sex-related differences in primary intracerebral hemorrhage

Changes in Functional Outcome Over the First Year After Stroke

Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

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