Sex-Based Differences in the Outcomes of Intracerebral Haemorrhage: A Systematic Review and Meta-Analysis

Introduction: The aim of the study was to provide updated evidence on the sex-based differences in the risk of mortality and functional outcomes in subjects with intracerebral haemorrhage. Methods: A systematic search of eligible studies was conducted using three large databases such as PubMed, EMBASE, and Scopus for observational studies that documented the comparative risk of mortality and functional outcomes based on the subjects' sex. Only studies published in the year 2000 and onwards were included. Random-effects model was used to pool relevant data, and effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CI). Results: The review included 32 studies. In most of the studies, female subjects had a higher mean age compared to males and had a higher rate of neurological deficits at admission. A higher proportion of males had cardiovascular risk factors. The risk of mortality at hospital discharge (OR 0.98, 95% CI: 0.90, 1.06), 1-month (OR 0.98, 95% CI: 0.81, 1.18), 3-month (OR 1.13, 95% CI: 0.95, 1.33), and 12-month (OR 1.04, 95% CI: 0.90, 1.19) follow-up was similar in both sexes. Compared to females, males had a lower risk of poor functional outcomes at 3-month (OR 0.83, 95% CI: 0.77, 0.89) and 12-month (OR 0.87, 95% CI: 0.77, 0.98) follow-up. Conclusion: There is a similar risk of mortality but better functional outcomes in males with intracerebral haemorrhage compared to females. However, the findings should be interpreted cautiously as there were significant sex-based differences in risk profiles at admission. Further studies that focus on careful and meticulous examination of sex-specific association with survival and functional outcomes are needed.