Aneurysmal Subarachnoid Haemorrhage and Sex Difference: Analysis of Epidemiology, Outcomes and Risk Factors

Abstract Background and Purpose The differences in outcomes after aneurysmal subarachnoid haemorrhage (aSAH) between the different sexes remains controversial. This study aimed to study the differences in epidemiology, outcomes and risk factors between male and female aSAH patients. Methods We performed a multicentre retrospective study of aSAH patients from 2017 to 2020. We investigated epidemiology differences between the two sexes. Propensity score matching (PSM) was used to compare short-term outcomes in different sexes. Binary logarithmic regression was performed to investigate the odds ratio for dependent survival in different sexes. Results A total of 5407 consecutive aSAH patients were included in this study, and the female-to-male ratio was 1.8:1. The peak incidence of aSAH occurred in the 6 th and 7 th decade in males and females, respectively. Female patients had more ICA/PCoA aneurysms (53.2%), and male patients had more ACA/ACoA aneurysms (43.2%). The incidence of multiple aneurysms was higher in female patients (21.5% vs. 14.2%, P<0.001). There was no significant difference in outcomes before and after PSM at discharge. The dependent survival risk was only related to the clinical condition upon admission in females. In addition, age of more than 50 years (OR, 1.88; 95% CI, 1.17-3.02; P=0.01) and hypertension (OR, 1.81; 95% CI, 1.25-2.61; P=0.002) were also risk factors in male patients. Conclusions The number of female patients was higher than that of male patients. Most aneurysm locations were different between the two groups. There was no significant difference in discharge outcomes before and after PSM. The risk factors for dependent survival were different in female and male patients.