Cyprien A Rivier, Daniela Renedo, Sandro Marini, Jessica R Magid-Bernstein, Adam de Havenon, Jonathan Rosand, Daniel F Hanley, Wendy C Ziai, Stephan A Mayer, Daniel Woo, Lauren H Sansing, Kevin N Sheth, Christopher D Anderson, Guido J Falcone
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引用次数: 0
Abstract
Objective: The limited existing evidence on sex differences in the clinical characteristics of patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH) comes from small, single-center studies. Here, we performed an individual patient data meta-analysis of 3 randomized clinical trials and 1 multi-ethnic observational study of ICH to investigate the impact of sex on ICH severity and outcome.
Methods: Inclusion criteria in our study were a neuroimaging-confirmed ICH. We evaluated whether sex was associated with ICH severity (hematoma volume and expansion) and poor functional outcomes (modified Rankin Scale >3) 3 or 6 months after the ICH.
Results: A total of 4,812 ICH patients were evaluated (mean age 62, 40% female). Males with ICH were younger, more likely to be smokers and have diabetes, and less likely to be on anticoagulants (all p < 0.05). In multivariable analyses, male sex was associated with non-lobar location (odds ratio [OR]: 1.63; 95% confidence interval [CI]: [1.39-1.92]; p < 0.001), larger hemorrhages (beta: 0.16 [0.08-0.23]; p < 0.001) and a higher risk of hematoma expansion (OR: 1.43 [1.20-1.71]; p < 0.001). Despite the larger hemorrhage volume and higher risk of expansion, male sex was associated with a 24% lower risk of poor outcomes (OR: 0.76 [0.64-0.90]; p = 0.002).
Interpretation: Compared to females, males with ICH have larger bleeds and higher risk of hematoma expansion. Despite the larger bleeds and higher risk of hematoma expansion, males with ICH have lower risk of poor outcomes. Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition. ANN NEUROL 2024.
目的：关于自发性非外伤性脑内出血（ICH）患者临床特征的性别差异，现有的有限证据均来自小型单中心研究。在此，我们对 3 项随机临床试验和 1 项多种族 ICH 观察性研究的单个患者数据进行了荟萃分析，以研究性别对 ICH 严重程度和预后的影响：我们研究的纳入标准是神经影像学确诊的 ICH。我们评估了性别是否与 ICH 严重程度（血肿体积和扩大）和 ICH 3 个月或 6 个月后的不良功能预后（修正的 Rankin 量表>3）相关：共评估了 4812 名 ICH 患者（平均年龄 62 岁，女性占 40%）。男性 ICH 患者更年轻，更有可能是吸烟者和糖尿病患者，服用抗凝药物的可能性较低（均为 p）：与女性相比，男性 ICH 患者的出血量更大，血肿扩大的风险更高。尽管男性 ICH 患者出血量较大，血肿扩大的风险较高，但其不良预后的风险较低。我们的研究结果表明，女性和男性 ICH 患者的生物学特性和临床轨迹是不同的，这支持了针对这种疾病的性别特异性研究。ann neurol 2024.
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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