Introduction: Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is associated with a worse outcome1, 2. In addition to WFNS grading and Fisher score, several new risk factors for the development of DCI have recently been identified3; these are smoking, history of diabetes mellitus, systemic inflammatory response syndrome, hyperglycemia and hydrocephalus. Women, especially postmenopausal, have a higher risk for aneurysm rupture and there is limited data on the role of gender and hormonal status in the development of DCI4. We investigated the relation between gender and menopausal status to the development of DCI of delayed cerebral infarction.
Methods: We screened the SAHIT database (SAH International Trialists collaboration5) for studying gender as a risk factor for both DCI and delayed cerebral infarction. Relationships between the above mentioned variables were examined with a fixed effect model. Risk differences for DCI and delayed cerebral infarcts between man and women were calculated. Additionally, women were split into two groups according to age (< vs. > 50 years) to examine the menopausal status.
Results: Six prospective databases were selected with a total of 8,388 patients for evaluation of DCI and cerebral infarction. In the univariate analysis, gender and menopausal status were a significant predictor for DCI and delayed cerebral infarction. The adjusted analysis showed no significant risk differences, although there was a tendency for a higher risk for DCI in postmenopausal women (p=0.07).
Conclusions: Gender and menopausal status appear not to be an independent risk factor for the development of DCI or delayed cerebral infarction. These parameters do not have to be incorporated into clinical prediction models.
Patient Care: Optimization of prediction models for patients with SAH
Learning Objectives: risk factors for delayed cerebral ischemia and delayed cerebral infarction.
References: (1)Etminan N, Vergouwen MD, Macdonald RL. Angiographic vasospasm versus cerebral infarction as outcome measures after aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl 2013;115:33-40.
(2)Vergouwen MD. Vasospasm versus delayed cerebral ischemia as an outcome event in clinical trials and observational studies. Neurocrit Care 2011 September;15(2):308-11.
(3)de Rooij NK, Rinkel GJ, Dankbaar JW, Frijns CJ. Delayed cerebral ischemia after subarachnoid hemorrhage: a systematic review of clinical, laboratory, and radiological predictors. Stroke 2013 January;44(1):43-54.
(4)Algra AM, Klijn CJ, Helmerhorst FM, Algra A, Rinkel GJ. Female risk factors for subarachnoid hemorrhage: a systematic review. Neurology 2012 September 18;79(12):1230-6.
(5)Macdonald RL, Cusimano MD, Etminan N, Hanggi D, Hasan D, Ilodigwe D, Jaja B, Lantigua H, Le RP, Lo B, Louffat-Olivares A, Mayer S, Molyneux A, Quinn A, Schweizer TA, Schenk T, Spears J, Todd M, Torner J, Vergouwen MD, Wong GK. Subarachnoid Hemorrhage International Trialists data repository (SAHIT). World Neurosurg 2013 March;79(3-4):418-22.