Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage

SAHIT collaborators

doi:10.3171/2017.3.JNS162808

Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage

SAHIT collaborators

Anesthesiology

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.

Original language	English (US)
Pages (from-to)	458-464
Number of pages	7
Journal	Journal of neurosurgery
Volume	129
Issue number	2
DOIs	https://doi.org/10.3171/2017.3.JNS162808
State	Published - Aug 2018

Bibliographical note

Funding Information:
sity Medical Center Groningen, the Netherlands; Nima Etminan: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Daniel Hanggi: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; David Hasan: The Roy J. and Lucille A. Carver School of Medicine, University of Iowa, Iowa City, Iowa; S. Claiborne Johnston: Dell Medical School, University of Texas, Austin, Texas; Peter Kirkpatrick: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Peter Le Roux: MLHC Brain & Spine Center at Lanke-nau Medical Center, Wynnewood, Pennsylvania; Stephan Mayer: Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Andrew Molyneux: The Manor Hospital, Oxford, United Kingdom; Adam Noble: Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool, United Kingdom; John Pickard: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Audrey Quinn: The General Infirmary, Leeds, United Kingdom; Karl Schaller: Service of Neurosurgery, University Hospital of Geneva, Switzerland; Thomas Schenk: Department of Neurology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Tom Schweizer: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada; Julian Spears: Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada; Michael Todd: Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa; James Torner: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa; Ming-Yuan Tseng: Medicines and Healthcare Products Regulatory Agency, University of Cambridge, United Kingdom; Mervyn Vergouwen: Department of Neurology, University Medical Center Utrecht, the Netherlands; and George Wong: Department of Surgery, Chinese University of Hong Kong, China.

Funding Information:
Therapeutics Inc., is a consultant for Actelion Pharmaceuticals, Ltd., has direct stock ownership in Edge Therapeutics, receives non–study-related clinical/research support, and has ownership in the Heart and Stroke Foundation of Canada and the Brain Aneurysm Foundation.

Publisher Copyright:
© AANS 2018.

Keywords

Brain ischemia
Cohort study
Delayed cerebral ischemia
Risk factor in epidemiology
Sex
Subarachnoid hemorrhage
Vascular disorders

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@article{c7d330c7a3c94be7a36f2245db44ece1,

title = "Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage",

abstract = "OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.",

keywords = "Brain ischemia, Cohort study, Delayed cerebral ischemia, Risk factor in epidemiology, Sex, Subarachnoid hemorrhage, Vascular disorders",

author = "{SAHIT collaborators} and Germans, {Menno R.} and Jaja, {Blessing N.R.} and {De Oliviera Manoel}, {Airton Leonardo} and Cohen, {Ashley H.} and Macdonald, {R. Loch} and {Van Den Bergh}, Walter and Nima Etminan and Daniel Hanggi and David Hasan and Johnston, {S. Claiborne} and Peter Kirkpatrick and {Le Roux}, Peter and Stephan Mayer and Andrew Molyneux and Adam Noble and John Pickard and Audrey Quinn and Karl Schaller and Thomas Schenk and Tom Schweizer and Julian Spears and Michael Todd and James Torner and Tseng, {Ming Yuan} and Mervyn Vergouwen and George Wong",

note = "Funding Information: sity Medical Center Groningen, the Netherlands; Nima Etminan: Department of Neurosurgery, Medical Faculty Heinrich Heine University, D{\"u}sseldorf, Germany; Daniel Hanggi: Department of Neurosurgery, Medical Faculty Heinrich Heine University, D{\"u}sseldorf, Germany; David Hasan: The Roy J. and Lucille A. Carver School of Medicine, University of Iowa, Iowa City, Iowa; S. Claiborne Johnston: Dell Medical School, University of Texas, Austin, Texas; Peter Kirkpatrick: Department of Clinical Neurosciences, Addenbrooke{\textquoteright}s Hospital, University of Cambridge, United Kingdom; Peter Le Roux: MLHC Brain & Spine Center at Lanke-nau Medical Center, Wynnewood, Pennsylvania; Stephan Mayer: Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Andrew Molyneux: The Manor Hospital, Oxford, United Kingdom; Adam Noble: Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool, United Kingdom; John Pickard: Department of Clinical Neurosciences, Addenbrooke{\textquoteright}s Hospital, University of Cambridge, United Kingdom; Audrey Quinn: The General Infirmary, Leeds, United Kingdom; Karl Schaller: Service of Neurosurgery, University Hospital of Geneva, Switzerland; Thomas Schenk: Department of Neurology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Tom Schweizer: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael{\textquoteright}s Hospital, Toronto, Ontario, Canada; Julian Spears: Division of Neurosurgery, St. Michael{\textquoteright}s Hospital, University of Toronto, Ontario, Canada; Michael Todd: Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa; James Torner: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa; Ming-Yuan Tseng: Medicines and Healthcare Products Regulatory Agency, University of Cambridge, United Kingdom; Mervyn Vergouwen: Department of Neurology, University Medical Center Utrecht, the Netherlands; and George Wong: Department of Surgery, Chinese University of Hong Kong, China. Funding Information: Therapeutics Inc., is a consultant for Actelion Pharmaceuticals, Ltd., has direct stock ownership in Edge Therapeutics, receives non–study-related clinical/research support, and has ownership in the Heart and Stroke Foundation of Canada and the Brain Aneurysm Foundation. Publisher Copyright: {\textcopyright} AANS 2018.",

year = "2018",

month = aug,

doi = "10.3171/2017.3.JNS162808",

language = "English (US)",

volume = "129",

pages = "458--464",

journal = "Journal of neurosurgery",

issn = "0022-3085",

publisher = "American Association of Neurological Surgeons",

number = "2",

}

TY - JOUR

T1 - Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage

AU - SAHIT collaborators

AU - Germans, Menno R.

AU - Jaja, Blessing N.R.

AU - De Oliviera Manoel, Airton Leonardo

AU - Cohen, Ashley H.

AU - Macdonald, R. Loch

AU - Van Den Bergh, Walter

AU - Etminan, Nima

AU - Hanggi, Daniel

AU - Hasan, David

AU - Johnston, S. Claiborne

AU - Kirkpatrick, Peter

AU - Le Roux, Peter

AU - Mayer, Stephan

AU - Molyneux, Andrew

AU - Noble, Adam

AU - Pickard, John

AU - Quinn, Audrey

AU - Schaller, Karl

AU - Schenk, Thomas

AU - Schweizer, Tom

AU - Spears, Julian

AU - Todd, Michael

AU - Torner, James

AU - Tseng, Ming Yuan

AU - Vergouwen, Mervyn

AU - Wong, George

N1 - Funding Information: sity Medical Center Groningen, the Netherlands; Nima Etminan: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Daniel Hanggi: Department of Neurosurgery, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; David Hasan: The Roy J. and Lucille A. Carver School of Medicine, University of Iowa, Iowa City, Iowa; S. Claiborne Johnston: Dell Medical School, University of Texas, Austin, Texas; Peter Kirkpatrick: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Peter Le Roux: MLHC Brain & Spine Center at Lanke-nau Medical Center, Wynnewood, Pennsylvania; Stephan Mayer: Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Andrew Molyneux: The Manor Hospital, Oxford, United Kingdom; Adam Noble: Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool, United Kingdom; John Pickard: Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, United Kingdom; Audrey Quinn: The General Infirmary, Leeds, United Kingdom; Karl Schaller: Service of Neurosurgery, University Hospital of Geneva, Switzerland; Thomas Schenk: Department of Neurology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Tom Schweizer: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada; Julian Spears: Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada; Michael Todd: Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa; James Torner: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa; Ming-Yuan Tseng: Medicines and Healthcare Products Regulatory Agency, University of Cambridge, United Kingdom; Mervyn Vergouwen: Department of Neurology, University Medical Center Utrecht, the Netherlands; and George Wong: Department of Surgery, Chinese University of Hong Kong, China. Funding Information: Therapeutics Inc., is a consultant for Actelion Pharmaceuticals, Ltd., has direct stock ownership in Edge Therapeutics, receives non–study-related clinical/research support, and has ownership in the Heart and Stroke Foundation of Canada and the Brain Aneurysm Foundation. Publisher Copyright: © AANS 2018.

PY - 2018/8

Y1 - 2018/8

N2 - OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.

AB - OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I2 statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study. An additional model was examined in which women and men were split into groups according to an age cut point of 55 years, as a surrogate to define hormonal status. RESULTS A pooled cohort of 6713 patients was analyzed. The risk of DCI was statistically significantly higher in women than in men (OR 1.29, 95% CI 1.12-1.48); no difference was found with respect to cerebral infarction (OR 1.17, 95% CI 0.98-1.40). No difference was found in the risk of DCI when comparing women ≤ 55 and > 55 years (OR 0.87, 95% CI 0.74-1.02; p = 0.08) or when comparing men ≤ 55 and > 55 years (p = 0.38). Independent predictors of DCI were World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, age, and sex. Independent predictors of infarction included WFNS grade, Fisher grade, and aneurysm size. CONCLUSIONS Female sex is associated with a higher risk of DCI. Sex differences may play a role in the pathogenesis of DCI but are not associated with menopausal status. The predictors of DCI and cerebral infarction were identified in a very large cohort and reflect experience from multiple institutions.

KW - Brain ischemia

KW - Cohort study

KW - Delayed cerebral ischemia

KW - Risk factor in epidemiology

KW - Sex

KW - Subarachnoid hemorrhage

KW - Vascular disorders

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EP - 464

JO - Journal of neurosurgery

JF - Journal of neurosurgery

IS - 2

ER -

Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage

Abstract

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