Abstract P434: Sex Differences in Outcomes After Subarachnoid Hemorrhage: Insight From the Subarachnoid Hemorrhage International Trialists Repository

Abstract

Introduction: Sex is a known predictor of outcome after acute ischemic stroke. However, the effect of sex on outcome after subarachnoid hemorrhage (SAH) is not well studied. Methods: Five studies from the SAH International Trialists repository were included (4 randomized trials and 1 prospective study). Patients were divided into groups based on sex. The primary outcome was favorable outcome which was defined as Glasgow Outcome Score (GOS) of 4 or 5 and the secondary outcome was delayed cerebral ischemia (DCI). Binary logistic regression was done to assess the association between sex and outcomes. Results: A total of 8015 patients (2186 males and 5829 females) were included. Female patients were older (mean age 53 vs 50 years, p<0.001) and had more severe neurological deficit on presentation (median World Federation of Neurosurgical Societies [WFNS] grade 2 vs.1; p<0.001). Favorable outcome was achieved less frequently in females in univariate analysis (51% vs. 62%; p<0.001). In a multivariable model adjusted for age, WFNS, Fisher score, aneurysm location, and aneurysm size, female was associated with lower odds of favorable outcome (OR= 0.82; 95% CI:0.73-0.92). DCI occurred more frequently in females (25% vs. 18%; p<0.001). In addition, women had higher risk of DCI after adjusting for potential confounders (women vs. men, OR 1.43; 95%CI: 1.26-1.63). We did not find an interaction between age and sex for both favorable outcome and clinical vasospasm. Conclusion: Female patients had worse functional outcome and higher risk of DCI after subarachnoid hemorrhage when compared to men.