Table_1_Sex-specific extracerebral complications in patients with aneurysmal subarachnoid hemorrhage.docx

BackgroundExtracerebral complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) often occur during their stay at the neurocritical care unit (NCCU). Their influence on outcomes is poorly studied. The identification of sex-specific extracerebral complications in patients with aSAH and their impact on outcomes might aid more personalized monitoring and therapy strategies, aiming to improve outcomes.
MethodsConsecutive patients with aSAH admitted to the NCCU over a 6-year period were evaluated for the occurrence of extracerebral complications (according to prespecified criteria). Outcomes were assessed with the Glasgow Outcome Scale Extended (GOSE) at 3 months and dichotomized as favorable (GOSE 5–8) and unfavorable (GOSE 1–4). Sex-specific extracerebral complications and their impact on outcomes were investigated. Based on the results of the univariate analysis, a multivariate analysis with unfavorable outcomes or the occurrence of certain complications as dependent variables was performed.
ResultsOverall, 343 patients were included. Most of them were women (63.6%), and they were older than men. Demographics, presence of comorbidities, radiological findings, severity of bleeding, and aneurysm-securing strategies were compared among the sexes. More women than men suffered from cardiac complications (p = 0.013) and infection (p = 0.048). Patients with unfavorable outcomes were more likely to suffer from cardiac (p < 0.001), respiratory (p < 0.001), hepatic/gastrointestinal (p = 0.023), and hematological (p = 0.021) complications. In the multivariable analysis, known factors including age, female sex, increasing number of comorbidities, increasing World Federation of Neurosurgical Societies (WFNS), and Fisher grading were expectedly associated with unfavorable outcomes. When adding complications to these models, these factors remained significant. However, when considering the complications, only pulmonary and cardiac complications remained independently associated with unfavorable outcomes.
ConclusionExtracerebral complications after aSAH are frequent. Cardiac and pulmonary complications are independent predictors of unfavorable outcomes. Sex-specific extracerebral complications in patients with aSAH exist. Women suffered more frequently from cardiac and infectious complications potentially explaining the worse outcomes.

一、研究背景：动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage, aSAH）患者的脑外并发症多发生于神经重症监护病房（neurocritical care unit, NCCU）住院期间，其对患者预后的影响目前尚缺乏深入研究。明确动脉瘤性蛛网膜下腔出血患者的性别特异性脑外并发症及其对预后的影响，或有助于制定更具个性化的监测与治疗策略，进而改善患者预后。二、研究方法：本研究对6年间收治于神经重症监护病房的连续性动脉瘤性蛛网膜下腔出血患者进行回顾分析，依据预先设定的评判标准评估其脑外并发症发生情况。于患者发病后3个月采用扩展格拉斯哥预后量表（Glasgow Outcome Scale Extended, GOSE）评估预后，并将其二分类为预后良好组（GOSE评分5~8分）与预后不良组（GOSE评分1~4分）。分析不同性别的脑外并发症发生情况及其对预后的影响。基于单因素分析结果，以预后不良或特定并发症发生为因变量，开展多因素回归分析。三、研究结果：本研究共纳入343例患者，其中女性占比63.6%，且女性患者平均年龄高于男性。对不同性别患者的人口学特征、合并症情况、影像学表现、出血严重程度及动脉瘤处理策略进行了比较。女性患者较男性更易发生心脏并发症（p=0.013）与感染（p=0.048）。预后不良组患者更易出现心脏并发症（p<0.001）、呼吸系统并发症（p<0.001）、肝/胃肠道并发症（p=0.023）及血液系统并发症（p=0.021）。多因素分析显示，年龄、女性性别、合并症数量增多、世界神经外科医师联盟（World Federation of Neurosurgical Societies, WFNS）分级升高及Fisher分级升高这些已知危险因素，均与预后不良显著相关。将并发症纳入上述模型后，上述危险因素仍具有统计学意义。但仅肺部并发症与心脏并发症仍为预后不良的独立危险因素。四、研究结论：动脉瘤性蛛网膜下腔出血患者术后脑外并发症较为常见。心脏并发症与肺部并发症是预后不良的独立预测因素。动脉瘤性蛛网膜下腔出血患者存在性别特异性脑外并发症差异，女性患者更易发生心脏与感染性并发症，这或可部分解释其预后更差的原因。