AUTHOR=Bögli Stefan Y. , Beham Sabrina , Hirsbrunner Laura , Nellessen Friederike , Casagrande Francesca , Keller Emanuela , Brandi Giovanna 

TITLE=Sex-specific extracerebral complications in patients with aneurysmal subarachnoid hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1098300

DOI=10.3389/fneur.2023.1098300

ISSN=1664-2295

ABSTRACT=Background
Extracerebral complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) often occur during the stay at the neutocritical care unit (NCCU). Their influence on outcome is poorly studied.  The identification of sex-specific extracerebral complications in patients with aSAH and their impact on outcome might aide more personalized monitoring and therapy strategies, aiming to improve outcome. 
Methods
Consecutive patients with aSAH admitted to the neurocritical care unit over a six-year period were evaluated for the occurrence of extracerebral complications (according to prespecified criteria).  Outcome was assessed with the Glasgow Outcome Scale Extended (GOSE) at three months and dichotomized as favorable (GOSE 5-8) and unfavorable (GOSE 1-4). Sex-specific extracerebral complications and their impact on outcome was investigated. Based on the results of the univariate analysis, a multivariate analysis with unfavorable outcome or the occurrence of certain complications as dependent variables was performed. 
Results
Overall, 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 comparable among sexes. More women than men suffered from cardiac (p=0.013) and infections (p=0.048) complications. Patients with unfavorable outcome 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 multivariate 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 outcome. 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 outcome. 
Conclusions
The extracerebral complications after aSAH are frequent. Cardiac and pulmonary complications are independent predictors of unfavorable outcome. Sex-specific extracerebral complications in patients with aSAH exist. Women suffered more frequently from cardiac and infectious complications potentially explaining the worse outcome.