Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Fuentes, Angelica M.; McGuire, Laura Stone; Amin‐Hanjani, Sepideh

doi:10.1161/strokeaha.121.037147

Cited by 53 publications

(51 citation statements)

References 119 publications

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“…In addition, we found that the location of aneurysms and irregular shape of IA were also associated with RIA, which was consistent with previous studies ( Greving et al, 2014 ; Fuentes et al, 2022 ; Wang et al, 2022 ). Future studies with larger sample sizes are needed to assess other associated factors.…”

Section: Discussionsupporting

confidence: 93%

“…These results suggest that Hcy levels may be related to the rupture of IA. Many risk factors have been reported to be associated with the rupture of IA, such as female sex, smoking, aneurysm location, aneurysm size, number of aneurysms, and a family history of SAH (Wiebers et al, 2003;Greving et al, 2014;Fuentes et al, 2022;Wang et al, 2022). However, these factors can only explain the risk of rupture of aneurysms to some extent (Kleinloog et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is of great clinical significance to accurately assess the risk of rupture in patients with UIA. Previous studies have focused on the effects of clinical factors of UIA patients, such as sex, age, hypertension, and aneurysmal morphological factors (size and location) ( Greving et al, 2014 ; Fuentes et al, 2022 ; Wang et al, 2022 ). However, few studies have investigated the role of biomarkers in IA rupture.…”

Section: Introductionmentioning

confidence: 99%

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Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms

Wei

Yuan

et al. 2022

Front. Neurosci.

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BackgroundHomocysteine (Hcy) levels may be associated with the development of intracranial aneurysms (IAs). However, whether it increases the risk of rupture of IAs is unknown. This study aimed to determine the association between homocysteine levels and IA rupture.MethodsWe retrospectively reviewed patients with IAs and subarachnoid hemorrhage (SAH) at our hospital between January 2019 and May 2021. Clinical data, including Hcy levels and IA images, were assessed. The association between Hcy level and IA rupture was investigated using multivariate logistic regression analyses in patients with IAs and SAH.ResultsA total of 589 patients were included. 546 patients with IAs, including 331 UIA (Unruptured IA) and 215 RIA (Ruptured IA). The average age was 57.43 ± 10.86 years old, and 67.03% were women. Among them, all 215 RIAs lead to SAH. In addition, we also enrolled 43 non-aneurysmal subarachnoid hemorrhage (Na-SAH) patients. The average age was 54.12 ± 10.55 years old, and 53.48% were female. After adjusting for confounders in the multivariate model, Hcy levels were correlated with the rupture of IA (odds ratio [OR] 1.069; 95% confidence interval [CI] 1.025–1.114, p = 0.002) and a-SAH (OR 1.083; 95% CI 1.002–1.170, p = 0.046).ConclusionHcy levels were associated with IA rupture. These findings provide novel insights into IAs rupture, and future studies are needed to confirm this relationship.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms

Wei

Yuan

et al. 2022

Front. Neurosci.

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“…These were selected during consensus meetings of the study steering committee as those demonstrated to have potential associations with SAH outcome. [25][26][27] The primary outcome was dependency or death (mRS 3-6). The prespecified covariables were age, sex, modified Fisher grade, WFNS grade, aneurysm location and whether complications including vasospasm, ventriculitis or hydrocephalus occurred during admission up to 21 days, discharge or death.…”

Section: Discussionmentioning

confidence: 99%

“…To analyse associations of hyponatraemia with outcome, we used multiple logistic regression fit by maximum likelihood estimation, adjusting for prespecified covariates. These were selected during consensus meetings of the study steering committee as those demonstrated to have potential associations with SAH outcome 25–27. The primary outcome was dependency or death (mRS 3–6).…”

Section: Methodsmentioning

confidence: 99%

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

et al. 2022

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BackgroundHyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH.MethodsWe prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression.Results175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia.ConclusionsIn this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.

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Vascular Neurosurgery (Aneurysm) and Neurocritical Care

Sengupta,

Mahajan

2024

Principles and Practice of Neurocritical Care

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Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Cited by 53 publications

References 119 publications

Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms

Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Vascular Neurosurgery (Aneurysm) and Neurocritical Care

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