Sex differences in outcomes and risk factors among elderly patients with ischemic stroke

Zou, Chunying; Wei, Chun-Jie; Wang, Zeng-Mian; Jin, Yuling

doi:10.18632/oncotarget.21967

Cited by 6 publications

(4 citation statements)

References 40 publications

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“…Similarly to Swedish patients [30], no differences were found in the prescription rate of anticoagulants after an ischaemic stroke. Higher proportions of AF and hypertension in women have also been reported in other cohorts [9,28,29,31].…”

Section: Discussionsupporting

confidence: 63%

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland

Wiszniewska¹,

Fryze

Wiśniewska

et al. 2020

Neurol Neurochir Pol.

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Aim of study. We investigated sex differences in ischaemic stroke patients treated with intravenous alteplase. Clinical rationale for study. We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study.Materials and methods. This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality.Results. Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). Conclusions:Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.

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Section: Discussionsupporting

confidence: 63%

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland

Wiszniewska¹,

Fryze

Wiśniewska

et al. 2020

Neurol Neurochir Pol.

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“…In accordance with the results of our study, in literature it was proven that the prevalence of stroke in females is lower than males, and several studies have shown that females suffered from more severe strokes, had higher short-term mortality than males, but long-term sex differences in mortality persist up to 5 years after stroke (10,11,12). Ghosh et al also reported that female patients had significantly higher incidence of poor outcome, but female gender was not a significant predictor of stroke severity and mortality (6).…”

Section: -4: Resultssupporting

confidence: 92%

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

Arslan

Cilli

2019

IJMBS

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Aim: Our aim is to evaluate vascular risk factors and laboratory findings in patients treated with IV thrombolysis, to compare these parameters according to neurological findings scored by a National Institutes of Health Stroke Scale (NIHSS) at admission, after 7 days and to investigate the impact of these parameters on stroke severity and outcome at 3rd month. Methods: We reviewed 53 consecutive acute ischemic stroke patients admitted within 0-4.5 h after stroke onset and treated with IV thrombolysis between 2014 March-2018 May. Patients with acute posterior circulation stroke, and who underwent endovascular intervention after thrombolysis were excluded. Demographic features, vascular risk factors, laboratory findings and hemorrhagic transformation, and NIHSS scores of patients at admission and after 7 days, and also 3rd month mRS scores were recorded. Results: The mean age of patients was 64.79±12.26 and 60.37 % of them were male. Mean NIHSS score at admission was 10.60±5.16 and one week after IV r-tPA treatment, the mean score was 7.07±5.39. Hemorrhagic transformation was 18.9%. The male ratio was significantly higher in mild-moderate stroke group (p=0.008), the prevalence of hypertension, diabetes, hemorrhagic transformation and blood urea levels were also significantly higher in severe stroke group than mild-moderate group (p≤ 0.05). In addition neutrophil levels was higher in severe group, but not statistically significant. Creatine levels were significantly higher in the poor outcome group (NIHSS difference <6) after one week. Conclusion: Female gender, hemorrhagic transformation and high neutrophil levels were found to have impact on stroke severity towards poor prognosis independently.

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“…A study in Italy also showed that NIHSS score was an important predictor of functional decline at 3 months (17). A study of gender differences in China also found that stroke severity was an independent risk factor for mortality, dependence, and recurrence in men and women at 3 and 12 months after stroke (22). In our study, the results showed an increased risk of prognosis (mortality, recurrence, and dependence) in moderate and severe relative to mild stroke over three periods.…”

Section: Discussionmentioning

confidence: 93%

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

Cui

Xie

et al. 2021

Front. Neurol.

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Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

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Sex differences in outcomes and risk factors among elderly patients with ischemic stroke

Cited by 6 publications

References 40 publications

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

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