Sex differences in intracerebral hemorrhage expansion and mortality

Background and objective: Due to conflicting results in multiple studies, uncertainty remains regarding sex differences in severity and mortality after intracerebral hemorrhage (ICH). We investigated the impact of sex on ICH severity, expansion, and mortality. Methods: We analyzed prospectively collected ICH patients and assessed clinical variables and mortality rate. Mediation analyses were used to examine associations between sex and mortality and sex and hematoma expansion. Results: 2212 patients were investigated, 53.5% male. Men with ICH were younger (72 vs. 77 years), had greater smoking and alcohol use, and were more likely to have hypertension, diabetes, hypercholesterolemia and coronary artery disease (all p < 0.05). Lobar hemorrhages were more frequent in women (47.6% vs 38.4%, p < 0.001). Male sex was a risk factor for hematoma expansion (Odd Ratio (OR) 1.7, 95% confidence interval (CI) 1.15-2.50, p = 0.007). Multivariable analysis found that male sex was independently associated with 90 day mortality (OR 2.15 (95% CI 1.46-3.19), p < 0.001), and one-year mortality (Hazard Ratio 1.28 (95% CI: 1.09-1.50), p = 0.003). Early hematoma expansion mediated a portion of the association between sex and mortality (mediation p = 0.02). Conclusions: Men with ICH experience a higher risk of both expansion and early and late mortality, even after controlling for known risk factors. Further research is needed to explore the biological mechanisms underlying these observed differences. (C) 2017 Elsevier B.V. All rights reserved.