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Female Gender Remains an Independent Risk Factor for Poor Outcome after Acute Nontraumatic Intracerebral Hemorrhage

DOI: 10.1155/2013/219097

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Abstract:

Objective. To study whether gender influences outcome after intracerebral hemorrhage (ICH). Methods. Cohort study of 245 consecutive adults presenting to the emergency department with spontaneous ICH from January 2006 to December 2008. Patients with subarachnoid hemorrhage, extradural hemorrhage, and recurrence of hemorrhage were excluded. Results. There were no differences noted between genders in stroke severity (NIHSS) at presentation, ICH volume, or intraventricular extension (IVE) of hemorrhage. Despite this, females had 1.94 times higher odds of having a bad outcome (modified Rankin score (mRs) ) as compared to males (95% CI 1.12 to 3.3) and 1.84 times higher odds of early mortality (95% CI 1.02–3.33). analyzing known variables influencing mortality in ICH, the authors found that females did have higher serum glucose levels on arrival ( ) and 4.2 times higher odds for a cerebellar involvement than males (95% CI 1.63–10.75). After adjusting for age, NIHSS, glucose levels, hemorrhage volume, and IVE, female gender remained an independent predictor of early mortality ( ). Conclusions. Female gender may be an independent predictor of early mortality in ICH patients, even after adjustment for stroke severity, hemorrhage volume, IVE, serum glucose levels, and age. 1. Introduction Stroke is a priority public health problem for health systems worldwide today. Each year there are nearly 795,000 individuals who suffer from a new or recurrent stroke; 10% of these are cases of intracerebral hemorrhage. Stroke is the 4th leading cause of mortality according to the latest CDC statistics. Among all strokes, the case fatality rate for hemorrhagic strokes (37-38% mortality) is the highest [1], and most survivors have poor functional outcomes. Female gender has been recognized as an important risk factor for stroke, with NHANES reporting that women between 45 and 54 years of age were almost twice as likely to suffer from a stroke than males [2]. A greater decline was also seen in stroke-related deaths among males as compared to females between 1980 and 2005 [3]. There is a significant literature published on gender differences in outcomes of ischemic stroke. A recent review concluded that although the incidence of stroke was higher in males, females were more severely ill [4]. Internationally, it has been reported that the stroke burden is higher in females, because of a higher prestroke and poststroke disability [5–8]. This difference in disability after stroke between men and women is seen not only physically but also psychologically [9]. No published literature,

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