Men With ICH: Larger Bleeds but Better Outcomes?

TOPLINE:
Men with intracerebral hemorrhage (ICH) experience larger ICH volumes and a higher risk for deep bleeds than women, but they also have a lower risk for poor outcomes, a new study suggested.
METHODOLOGY:
Researchers conducted a meta-analysis of three randomized clinical trials and one multiethnic observational study, combining data from 4812 patients with primary, nontraumatic ICH (mean age, 62 years; 40% women).
ICH was confirmed using neuroimaging. Central evaluation of images by neurologists and neuroradiologists classified hemorrhage location, and hematoma volumes were measured using manual or semiautomated segmentation.
Outcome measures included ICH severity (hematoma volume and expansion), location (deep vs lobar), and functional outcomes assessed using modified Rankin Scale at 3 or 6 months post-ICH.
TAKEAWAY:
About 75% of patients had deep hemorrhages, and men with ICH had a significantly higher risk for deep hemorrhages than women (odds ratio [OR], 1.63; P < .001). This effect varied by race/ethnicity, with the risk being significant in White (OR, 2.19; P < .001) and Hispanic (OR, 1.85; P < .001) subgroups, but not in Black and Asian subgroups.
Male sex was significantly linked to larger ICH volumes in both lobar (P = .02) and deep (P < .001) hemorrhages, regardless of race.
Men also had a 43% higher risk for hematoma expansion than women (OR, 1.43; P ≤ .001).
Despite having more severe hemorrhages, men had a 24% lower risk for poor functional outcomes (OR, 0.76; P = .001) than women, with consistent results across various sensitivity analyses and outcome thresholds.
IN PRACTICE:
“Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition,” the investigators wrote.
SOURCE:
This study was led by Cyprien A. Rivier, MD, Yale School of Medicine, New Haven, Connecticut. It was published online on November 5 in Annals of Neurology.
LIMITATIONS:
The heterogeneity in this study design may have introduced biases, necessitating prospective replication to confirm the findings. The timing of outcome assessment at 3 months may have been too early to capture final recovery, particularly for larger bleeds. In addition, the sample size was insufficient for well-powered race/ethnic-specific analyses.
DISCLOSURES:
Eight of the 14 authors reported receiving external funding from various sources. Detailed disclosures are provided in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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