Abstract：
BACKGROUND: Whether there is a sex difference in the outcome of aneurysmal subarachnoid hemorrhage (aSAH) remains controversial, and clarifying the role of women in postoperative cerebral ischemic events can help us to understand its relationship with poor prognosis. Therefore, the purpose of this study was to elucidate the relationship between the three aspects of sex differences, postoperative cerebral ischemia, and poor prognosis after aSAH.
METHODS: A total of 472 patients admitted within 72 h after aSAH between January 2018 and December 2022 were included. We systematically analyzed the characteristics of sex differences in aSAH and explored the relationship between delayed cerebral ischemia (DCI), surgery-related cerebral infarction (SRCI), and poor prognosis (modified Rankin Scale > 2).
RESULTS: Compared with women, men were in worse condition and had more intracerebral hematoma (p = 0.001) on admission, whereas women were older (p < 0.001) and had more multiple aneurysms (p = 0.002). During hospitalization, men were more likely to experience emergency intubation (p = 0.036) and tracheotomy (p = 0.013). Women achieved functional independence at discharge at a similar rate to men (p = 0.394). Among postoperative complications, the incidence of DCI (22% vs. 12%, p = 0.01) and urinary tract infection (p = 0.022) was significantly higher in women. After adjusting for age, multivariable regression analysis showed that hypertension (odds ratio [OR] 2.139, 95% confidence interval [CI] 1.027-4.457), preoperative rerupture (OR 12.240, 95% CI 1.491-100.458), pulmonary infection (OR 2.297, 95% CI 1.070-4.930), external ventricular drainage placement (OR 4.382, 95% CI 1.550-12.390), bacteremia (OR 14.943, 95% CI 1.412-158.117), SRCI (OR 8.588, 95% CI 4.092-18.023), venous thrombosis (OR 5.283, 95% CI 1.859-15.013), higher modified Fisher grades (p = 0.003), and Hunt-Hess grades (p = 0.035) were associated with poor prognosis, whereas DCI (OR 1.394, 95% CI 0.591-3.292) was not an independent risk factor for poor prognosis. The proportion of patients who fully recovered from cerebral ischemia was higher in the DCI group (p < 0.001) compared with the SRCI group, and more patients were discharged with modified Rankin Scale > 2 in the SRCI group (p = 0.005).
CONCLUSIONS: Women have a higher incidence of DCI, but there is no sex difference in outcomes after aSAH, and poor prognosis is associated with worse admission condition and perioperative complications. SRCI is a strong independent risk factor for poor prognosis, whereas DCI is not.
METHODS: A total of 472 patients admitted within 72 h after aSAH between January 2018 and December 2022 were included. We systematically analyzed the characteristics of sex differences in aSAH and explored the relationship between delayed cerebral ischemia (DCI), surgery-related cerebral infarction (SRCI), and poor prognosis (modified Rankin Scale > 2).
RESULTS: Compared with women, men were in worse condition and had more intracerebral hematoma (p = 0.001) on admission, whereas women were older (p < 0.001) and had more multiple aneurysms (p = 0.002). During hospitalization, men were more likely to experience emergency intubation (p = 0.036) and tracheotomy (p = 0.013). Women achieved functional independence at discharge at a similar rate to men (p = 0.394). Among postoperative complications, the incidence of DCI (22% vs. 12%, p = 0.01) and urinary tract infection (p = 0.022) was significantly higher in women. After adjusting for age, multivariable regression analysis showed that hypertension (odds ratio [OR] 2.139, 95% confidence interval [CI] 1.027-4.457), preoperative rerupture (OR 12.240, 95% CI 1.491-100.458), pulmonary infection (OR 2.297, 95% CI 1.070-4.930), external ventricular drainage placement (OR 4.382, 95% CI 1.550-12.390), bacteremia (OR 14.943, 95% CI 1.412-158.117), SRCI (OR 8.588, 95% CI 4.092-18.023), venous thrombosis (OR 5.283, 95% CI 1.859-15.013), higher modified Fisher grades (p = 0.003), and Hunt-Hess grades (p = 0.035) were associated with poor prognosis, whereas DCI (OR 1.394, 95% CI 0.591-3.292) was not an independent risk factor for poor prognosis. The proportion of patients who fully recovered from cerebral ischemia was higher in the DCI group (p < 0.001) compared with the SRCI group, and more patients were discharged with modified Rankin Scale > 2 in the SRCI group (p = 0.005).
CONCLUSIONS: Women have a higher incidence of DCI, but there is no sex difference in outcomes after aSAH, and poor prognosis is associated with worse admission condition and perioperative complications. SRCI is a strong independent risk factor for poor prognosis, whereas DCI is not.
摘要：
背景：动脉瘤性蛛网膜下腔出血（aSAH）的结局是否存在性别差异仍存在争议，阐明女性在术后脑缺血事件中的作用可以帮助我们了解其与不良预后的关系。因此,这项研究的目的是阐明性别差异的三个方面之间的关系，术后脑缺血，aSAH后预后不良。
方法：纳入2018年1月至2022年12月aSAH后72小时内收治的472例患者。我们系统分析了aSAH的性别差异特点，并探讨了迟发性脑缺血(DCI)手术相关脑梗死(SRCI),预后不良(改良Rankin量表>2)。
结果：与女性相比，男性病情恶化，入院时脑内血肿较多（p=0.001），而女性年龄较大（p<0.001），多发动脉瘤较多（p=0.002）。住院期间,男性更有可能经历紧急插管(p=0.036)和气管切开术(p=0.013).女性在出院时实现功能独立的比率与男性相似（p=0.394）。在术后并发症中，DCI的发生率(22%vs.12%,p=0.01），女性尿路感染（p=0.022）明显较高。在调整了年龄之后,多元回归分析显示高血压(比值比[OR]2.139,95%置信区间[CI]1.027-4.457),术前再破裂（OR12.240，95%CI1.491-100.458），肺部感染（OR2.297，95%CI1.070-4.930），脑室外引流放置（OR4.382，95%CI1.550-12.390），菌血症（OR14.943，95%CI1.412-158.117），SRCI（OR8.588，95%CI4.092-18.023），静脉血栓形成（OR5.283，95%CI1.859-15.013），更高的修正费希尔等级(p=0.003)，Hunt-Hess评分（p=0.035）与不良预后相关，而DCI(OR1.394,95%CI0.591-3.292)不是不良预后的独立危险因素。DCI组脑缺血完全恢复的患者比例高于SRCI组(p<0.001),在SRCI组中，更多的患者出院，改良Rankin量表>2（p=0.005）。
结论：女性的DCI发生率较高，但aSAH后的结局没有性别差异，预后差与入院条件差和围手术期并发症有关。SRCI是预后不良的独立危险因素,而DCI不是。
方法：纳入2018年1月至2022年12月aSAH后72小时内收治的472例患者。我们系统分析了aSAH的性别差异特点，并探讨了迟发性脑缺血(DCI)手术相关脑梗死(SRCI),预后不良(改良Rankin量表>2)。
结果：与女性相比，男性病情恶化，入院时脑内血肿较多（p=0.001），而女性年龄较大（p<0.001），多发动脉瘤较多（p=0.002）。住院期间,男性更有可能经历紧急插管(p=0.036)和气管切开术(p=0.013).女性在出院时实现功能独立的比率与男性相似（p=0.394）。在术后并发症中，DCI的发生率(22%vs.12%,p=0.01），女性尿路感染（p=0.022）明显较高。在调整了年龄之后,多元回归分析显示高血压(比值比[OR]2.139,95%置信区间[CI]1.027-4.457),术前再破裂（OR12.240，95%CI1.491-100.458），肺部感染（OR2.297，95%CI1.070-4.930），脑室外引流放置（OR4.382，95%CI1.550-12.390），菌血症（OR14.943，95%CI1.412-158.117），SRCI（OR8.588，95%CI4.092-18.023），静脉血栓形成（OR5.283，95%CI1.859-15.013），更高的修正费希尔等级(p=0.003)，Hunt-Hess评分（p=0.035）与不良预后相关，而DCI(OR1.394,95%CI0.591-3.292)不是不良预后的独立危险因素。DCI组脑缺血完全恢复的患者比例高于SRCI组(p<0.001),在SRCI组中，更多的患者出院，改良Rankin量表>2（p=0.005）。
结论：女性的DCI发生率较高，但aSAH后的结局没有性别差异，预后差与入院条件差和围手术期并发症有关。SRCI是预后不良的独立危险因素,而DCI不是。
