Sex-Related Differences in Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage.
BACKGROUND
Several population-based studies found a higher case fatality after aneurysmal subarachnoid hemorrhage (ASAH) in women than in men. This may relate to differences in prognostic characteristics. We therefore assessed sex differences in prognosticators and outcome in ASAH patients.


METHODS
From a prospectively collected ASAH database, we retrieved data on patients admitted from 1990 to 2010. We calculated prevalence ratios (PRs) with corresponding 95% confidence intervals (CIs) for prognosticators (clinical condition on admission, site and treatment of the aneurysm, and complications during the clinical course) and risk ratios (RRs) for in-hospital death and poor outcome (death or dependence) at 3 months. RRs were adjusted for possible confounding with Poisson regression analysis.


RESULTS
Of the 1761 included patients, 1211 (68.8%) were women, who were 1.9 (95% CI: .5↔3.3) years older than men. PRs for women for the site of the aneurysm were 1.71 (95% CI: 1.38↔2.13) for the carotid artery, .68 (95% CI: .60↔.77) for the anterior communicating artery, 1.14 (95% CI: .92↔1.41) for the middle cerebral artery, and .85 (95% CI: .63↔1.13) for posterior circulation. PRs of other prognosticators were similar between sexes. The crude RR for in-hospital death for women was .91 (95% CI: .78↔1.05) and for poor outcome at 3 months was .95 (95% CI: .85↔1.06); both remained similar after adjustment.


CONCLUSIONS
In this study, in-hospital death and poor outcome at 3 months did not differ between men and women. Women were slightly older than men and had different distributions of aneurysm sites, but not to an extent that it explained a sex difference in outcome.
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Jesse J
JJ
Duijghuisen
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: p.greebe@umcutrecht.nl.
Paut
P
Greebe
Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Dennis J
DJ
Nieuwkamp
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Ale
A
Algra
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Gabriël J E
GJ
Rinkel
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018672:Community Health Planning; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000401:mortality
Subarachnoid hemorrhage; case fatality; in-hospital death; outcome; sex