ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Factors Associated with Progression and Sex-Specific Patterns in Chronic Subdural Hematoma: A Single-Centre Retrospective Study
Provisionally accepted
- 1Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- 2Huashan Hospital Fudan University, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Objective: This study aims to identify determinants of chronic subdural hematoma (CSDH) progression and to evaluate potential sex-related differences. Methods: Patients with unilateral CSDH were retrospectively enrolled between January 2018 and December 2024. Data on demographics, clinical characteristics, hematoma density, hematological parameters and coagulation function were collected. Multivariable logistic regression was used to identify independent predictors. Patients were randomly divided into training and validation cohorts in a 7:3 ratio to identify factors associated with hematoma progression. Subsequently, logistic regression models were applied to both cohorts to confirm the factors influencing progression. Results: This retrospective study enrolled 1142 patients, who were categorized into progression (n = 773, 67.69%) and recovery (n = 369, 32.31%) groups. Multivariate regression analysis revealed that international normalized ratio (INR) (OR 7.39, 95% CI 2.79–19.55), hypertension (OR 5.35, 95% CI 2.80–10.25), diabetes (OR 4.68, 95% CI 1.74–12.60), neutrophil to lymphocyte ratio (NLR) (OR 2.14, 95% CI 1.46–3.13), white blood cell count (WBC) (OR 1.16, 95% CI 1.02–1.31), and maximum hematoma density (MaHD) (OR 1.02, 95% CI 1.01–1.03) were independent risk factors for hematoma progression, whereas female gender (OR 0.61, 95% CI 0.40–0.95) was identified as a protective factor against CSDH progression. Subgroup analysis stratified by sex revealed statistically significant differences between female and male patients in hemoglobin concentration, serum albumin level, and platelet count. Nevertheless, all values remained within the respective sex-specific reference intervals. Conclusion: Elevated INR, hypertension, diabetes, NLR, WBC, and MaHD were independently associated with CSDH progression. Female sex conferred a protective effect. These findings require prospective validation.
Keywords: chronic subdural hematoma, Sex, coagulation, Inflammation, progression
Received: 27 Jul 2025; Accepted: 25 Nov 2025.
Copyright: © 2025 Yang, Du, Chen, Yuan, Fu, Fang, Hu and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jin Hu
Gang Wu
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.