Sex Differences in Profile and In-Hospital Death for Acute Stroke in Chile: Data From a Nationwide Hospital Registry.

BACKGROUND: Knowledge of local contextual sex differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex differences in the profile of patients with acute stroke and their associations with in-hospital death in the national hospital database of Chile. METHODS AND RESULTS: We present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis-Related Groups, which represents 70% of the operational expenditure of the public health system. Random-effects multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis International Classification of Diseases, Tenth Revision [ICD-10] codes) and in-hospital death, and reported with odds ratios (ORs) and 95% CIs. Of 1 048 575 hospital discharges, 15 535 were for patients with acute stroke (7074 [45.5%] in women), and 2438 (15.6%) of them died during hospitalization. Differences by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. After fully adjusted model, women with ischemic stroke had lower in-hospital death (OR, 0.79 [95% CI, 0.69-0.91]) compared with men; other independent predictors included age per year increase (OR, 1.03 [95% CI, 1.03-1.04]), chronic kidney disease (OR, 1.47 [95% CI, 1.20-1.80]), atrial fibrillation (OR, 1.50 [95% CI, 1.26-1.80]), and other risk factors. Conversely, for intracerebral hemorrhage, women had a higher in-hospital mortality rate than men (OR, 1.19 [95% CI, 1.02-1.40]); other independent predictors included age per year increase (OR, 1.009 [95% CI, 1.003-1.01]), chronic kidney disease (OR, 1.55 [95% CI, 1.23-1.97]), oral anticoagulant use (OR, 1.88 [95% CI, 1.37-2.58]), and other risk factors. CONCLUSIONS: Sex differences in characteristics and in-hospital death of hospitalized patients exist for acute stroke in Chile. In-hospital death is higher for acute ischemic stroke in men and higher for intracerebral hemorrhage in women. Future research is needed to better identify contributing factors.

Hemorragia intracerebral supratentorial espontânea: aspectos determinantes para melhor prognóstico funcional / Spontaneous supratentorial intracerebral hemorrhage: determining aspects for better functional prognosis

Objetivo: Detectar quais aspectos das hemorragias intracerebrais supratentoriais espontâneas lobares e de núcleos da base se correlacionam com melhor prognóstico funcional, além de analisar se os pacientes admitidos com GCS = 9 (Escala de Coma de Glasgow – GCS) que atingiram melhor prognóstico funcional após 30 dias do íctus foram beneficiados pelo tratamento cirúrgico. Método: Sessenta e sete pacientes (18 a 80 anos) com hematomas intraparenquimatosos espontâneos lobares e de núcleos da base foram avaliados quanto a idade, nível de consciência à admissão hospitalar, profundidade da lesão, volume do hematoma, ausência de hemoventrículo, desvio de linha média (DLM), tempo entre íctus e cirurgia, além da opção de tratamento (cirúrgico ou conservador), sendo correlacionados com a evolução funcional em 30 dias após o íctus da hemorragia (Escala de Resultados de Glasgow – GOS), considerando-se melhor prognóstico funcional se GOS = 3. Resultados: Nas hemorragias lobares, pacientes admitidos com GCS = 9 e com volume do hematoma < 50 ml alcançaram bom prognóstico funcional (p < 0,001). Houve tendência a bom resultado se DLM = 5 mm (p = 0,051), quando tratamento é cirúrgico (p = 0,098) e se não há hemoventrículo (p = 0,073). Nas hemorragias de núcleos da base, apenas pacientes admitidos com GCS = 9 atingiram bom resultado funcional (p = 0,009). Pacientes admitidos com GCS = 9 e que atingiram GOS = 3 foram beneficiados quando volume do hematoma é menor que 50 ml (p = 0,048). Pacientes com hemorragias lobares admitidos com GCS = 9 em deterioração neurológica tendem a ser beneficiados pela cirurgia. Conclusão: Todos os pacientes admitidos com GCS = 9 têm melhor prognóstico funcional. Pacientes com hemorragias lobares e lesões menores que 50 ml também são significativamente favorecidos, além de existir tendência à melhor evolução quando operados, sem hemoventrículo e com DLM = 5 mm. Se admitidos não comatosos (GCS = 9), hematomas pequenos colaboram para melhor resultado funcional, e pacientes com hemorragias lobares em deterioração neurológica tendem a se beneficiar com a cirurgia.

Objective: Determine which aspects of the lobar and basal ganglia spontaneous supratentorial intracerebral hemorrhage correlates with better functional outcome, and to analyze whether patients admitted with GCS = 9 (Glasgow Coma Scale – GCS) who achieved better functional outcome after 30 days of ictus were benefited by surgical treatment. Method: Sixty-seven patients (18-80 years) with spontaneous lobar and basal ganglia intraparenchymal hematomas were evaluated based as age, level of consciousness at hospital admission, lesion depth, hematoma volume, absence of ventricular hemorrhage, midline shift (MLS), time between hemorrhage and surgery, treatment option (surgery or conservative), being correlated with the functional evolution in 30 days after the bleeding (Glasgow Outcome Scale – GOS), considering good functional prognosis if GOS = 3. Results: In lobar hemorrhages, patients admitted with GCS = 9 and hematoma volume < 50 ml achieved good functional outcome (p < 0.001). There was a trend of good result if MLS = 5 mm (p = 0.051), choice of surgical treatment (p = 0.098) and absence of ventricular hemorrhage (p = 0.073). In basal ganglia hemorrhages only patients admitted with GCS = 9 achieved a good functional outcome (p = 0.009). Patients admitted with GCS = 9 and reached GOS = 3 were benefited when hematoma volume < 50 ml (p = 0.048). Patients with lobar hemorrhage admitted with GCS = 9 and were in neurological deterioration appear to be benefited by surgery. Conclusion: All patients admitted with GCS = 9 has better functional prognosis. Patients with lobar hemorrhages and lesions smaller than 50 ml are also significantly favored, besides there is a trend to better evolution when patients are operated, when there is an absence of ventricular hemorrhage and MLS = 5 mm. If not admitted comatose (GCS = 9), small bleeding (< 50 ml) collaborate to better functional outcome. Surgery shows a trend to benefit patients with lobar hemorrhage in neurological deterioration.