Gender Differences in Patients with Intracerebral Hemorrhage: A Hospital-Based Multicenter Prospective Study

Gender differences are well described for patients with ischemic stroke. Conversely, sex disparities in stroke presentation, risk factors, treatment, and outcomes for intracerebral hemorrhage (ICH) were not previously studied. Our objective was to compare the frequency of risk factors, management patterns, symptoms at presentation, complication rates, and outcomes between genders in patients with ICH in Fortaleza, Brazil. Methods: Data were prospectively collected from patients admitted to 19 hospitals in Fortaleza with a diagnosis of ICH by trained research coordinators from June 2009 to October 2010. Daily visits to the selected hospitals were performed, and all patients admitted with a diagnosis of ICH were prospectively evaluated. Results: We evaluated 364 patients, 47.5% of whom were women. Men were younger (59.3 +/- 14.58 years vs. 66.3 +/- 14.6 years, p < 0.001), more frequently smokers (33.1 vs. 16.6%, p ! 0.01) and had a higher frequency of alcohol abuse (48.5 vs. 8.2%, p < 0.01) than women. Women had a trend to have more dyslipidemia (41.1 vs. 31.3%, p = 0.12). Clinical presentation was similar between genders including the presence of motor and sensory deficits, headache, and depressed level of consciousness at presentation. Men had more speech disturbances than women (63.6 vs. 52.7%, p = 0.04). The time interval from symptoms onset to hospital admission was longer in women (25.1 +/- 82.4 h vs. 7.9 +/- 50.3 h, p = 0.08). Complication rates including pneumonia and deep vein thrombosis were not different between genders. Mortality was similar in both sexes (females: 35.8% vs. males: 33%, p = 0.66). Men were more frequently independent at discharge when evaluated by the modified Rankin Scale (mRS) score (mRS <= 2: 19.7% in men and 8.1% in women, p < 0.01). In the multivariate logistic regression analysis, older age, pre- stroke disability, depressed consciousness at admission, and female gender were independent predictors of poor outcome at discharge. Conclusion: Overall risk factors for ICH in men and women were similar in our series. Men had a higher frequency of alcohol abuse and smoking. Women were older, had an increased time length from symptoms onset to hospital admission and had a worse prognosis at discharge. A better understanding of the gender disparities in patients with ICH will hopefully lead to better outcomes in both sexes in the future. Copyright (C) 2012 S. Karger AG, Basel