Sex differences in intracerebral hemorrhage expansion and mortality

Abstract

Background and objective Due to conflicting results in multiple studies, uncertainty remains regarding sex differences in severity and mortality after intracerebral hemorrhage (ICH). We investigated the impact of sex on ICH severity, expansion, and mortality. Methods We analyzed prospectively collected ICH patients and assessed clinical variables and mortality rate. Mediation analyses were used to examine associations between sex and mortality and sex and hematoma expansion. Results 2212 patients were investigated, 53.5 % male. Men with ICH were younger (72 vs. 77 years), had greater smoking and alcohol use, and were more likely to have hypertension, diabetes, hypercholesterolemia and coronary artery disease (all p< 0.05). Lobar hemorrhages were more frequent in women (47.6% vs 38.4%, p<0.001). Male sex was a risk factor for hematoma expansion (Odd Ratio (OR) 1.7, 95% confidence interval (CI) 1.15 – 2.50, p=0.007). Multivariable analysis found that male sex was independently associated with 90-day mortality (OR 2.15 (95% CI 1.46–3.19), p<0.001), and one-year mortality (Hazard Ratio 1.28 (95% CI: 1.09–1.50), p=0.003). Early hematoma expansion mediated a portion of the association between sex and mortality (mediation p=0.02). Conclusions Men with ICH experience a higher risk of both expansion and early and late mortality, even after controlling for known risk factors. Further research is needed to explore the biological mechanisms underlying these observed differences.

Annexin A1 attenuates neuroinflammation through FPR2/p38/COX‐2 pathway after intracerebral hemorrhage in male mice

“…We chose to focus on the male gender in this study since several clinical studies have indicated that male sex could be one of the risk factors for spontaneous ICH (Marini et al, ; Roquer et al, ). In addition, estrogen has been shown to be protective in stroke (Faber, Moore, Lucitti, Aghajanian, & Zhang, ; Lee, Heo, Ambrosius, & Bushnell, ; Nakamura et al, ).…”

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

“…Gender ( 40 ) and age ( 41 ) are also associated with HE, as men and older subjects (age ≥85 years) are more likely to present HE than women and younger subjects ( 40 , 41 ).…”

Oligodendrocytes in intracerebral hemorrhage

“…The study also showed that women were older than men, although hematoma volume was similar in both sexes, suggesting that males are generally more susceptible to ICH than females . Similarly, a higher incidence (53.5%) of ICH was found in males in another study containing 2212 patients . Interestingly, this study identified male sex as a risk factor for hematoma expansion, which was defined as hematoma growth >33% or >6 mL from baseline ICH volume after 24 hours of onset …”

“…95 Similarly, a higher incidence (53.5%) of ICH was found in males in another study containing 2212 patients. 96 Interestingly, this study identified male sex as a risk factor for hematoma expansion, which was defined as hematoma growth >33% or >6 mL from baseline ICH volume after 24 hours of onset. 96 Whether age-and sex-related differences exist in oligodendrocyte biology remains largely unknown.…”

“…96 Interestingly, this study identified male sex as a risk factor for hematoma expansion, which was defined as hematoma growth >33% or >6 mL from baseline ICH volume after 24 hours of onset. 96 Whether age-and sex-related differences exist in oligodendrocyte biology remains largely unknown. A recent study reported that OPCs have distinct molecular signatures at different ages.…”