Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis

Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis Yuwei Han, Bingying Zhang, Xin Qi, Guanqian Yuan, Guobiao Liang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3942408/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 May, 2024 Read the published version in BMC Neurology → Version 1 posted 10 You are reading this latest preprint version Abstract Objective Sex differences in outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. Therefore, the aim of this study was to investigate the sex differences in the prognosis of patients with aSAH. Methods This study retrospectively analyzed the clinical data of aSAH patients admitted to the Department of Neurosurgery of General Hospital of Northern Theater Command, from April 2020 to January 2022. The modified Rankin Scale (mRS) was used to evaluate outcomes at 3-month post-discharge. Baseline characteristics, in-hospital complications and outcomes were compared after 1:1 propensity score matching (PSM). Results A total of 665 patients were included and the majority (63.8%) were female. Female patients were significantly older than male patients (59.3 ± 10.9 years vs. 55.1 ± 10.9 years, P < 0.001). After PSM, 141 male and 141 female patients were compared. Comparing postoperative complications and mRS scores, the incidence of delayed cerebral ischemia (DCI) and hydrocephalus and mRS ≥ 2 at 3-month were significantly higher in female patients than in male patients. After adjustment, the analysis of risk factors for unfavorable prognosis at 3-month showed that age, sex, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus were independent risk factors. Conclusions Female patients with aSAH have a worse prognosis than male patients, and this difference may be because females are more vulnerable to DCI and hydrocephalus. aneurysmal subarachnoid hemorrhage female propensity score matching outcome 1. Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is more prevalent in women than in men compared with other types of stroke [ 1 , 2 ] . Several studies have shown that females are associated with a poorer prognosis after aSAH compared to males [ 3 – 5 ] . Others have reported that sex is not a prognostic factor for aSAH prognosis [ 6 – 8 ] . Thus, it remains controversial whether outcomes following aSAH differ between men and women. Aneurysmal characteristics and complications including delayed cerebral ischemia (DCI) and hydrocephalus are the most important factors responsible for the poor prognosis of aSAH [ 9 , 10 ] . Several studies have shown that these factors may contribute to the sex differences in poor prognosis of aSAH. Other studies have reported sex differences in the site and location of ruptured aneurysms [ 8 , 11 ] . Therefore, this study retrospectively analyzed the clinical data of aSAH patients treated at our institution. The aim of this study was to investigate sex differences in the aneurysm characteristics, complications and 3-month prognosis. 2. Method 2.1 Patients’ material collection and variables This was a retrospective study, and all protocols were approved by the Ethics Committee of the General Hospital of Northern Theater Command, which was approved on 10 March 2023. Patients diagnosed with aSAH at the Neurosurgery Department of the General Hospital of Northern Theater Command from April 2020 to January 2022 were collected. All data analyses were performed in accordance with the Declaration of Helsinki and local ethical policies. And all patients were treated and managed according to guidelines. All patients were diagnosed with aSAH by computed tomography angiography (CTA) or digital subtraction angiography (DSA), and the location and number of aneurysms were clarified. If the patient had multiple intracranial aneurysms, the ruptured aneurysm was recorded as the responsible aneurysm. In this study, we have reviewed in detail information on the basic characteristics of patients, smoking and drinking, aneurysm characteristics, treatment approaches, and comorbidities. Aneurysms originating from various segments of the vertebral and basilar arteries and their branching aneurysms were recorded as posterior circulation artery (PCA) aneurysms. Aneurysms originating from the internal carotid artery, anterior and middle cerebral and their branching aneurysms were anterior circulation arterial (ACA) aneurysms.In this study, the treatment of all patients was categorized into intervention and craniotomy. Intervention mainly consisted of coil embolization and flow direction. Patients who underwent clipping or bypass were categorized as craniotomies. We set inclusion criteria including (1) age ≥ 18 years; (2) no history of ruptured aneurysm; (3) patients who underwent only craniotomy and intervention therapy; and (4) time from rupture to admission not exceeding 72 h, and time from admission to treatment not exceeding 72 h. To ensure the accuracy of the analysis, we excluded: (1) other neurological diseases (tumors, vascular malformations, Parkinson's disease) and functional or neurological deficits of the extremities from any cause; (2) history of neurosurgery prior to the rupture; (3) treatment with external ventricular drainage, lumbar puncture, angiography, intubation and/or mechanical ventilation in other hospitals prior to the visit to our clinic; (4) anemia on admission (hemoglobin < 120 g/L for male and < 110 g/L for female); (5) receiving or have received hormonal replacement therapy and (6) missing clinical data. 2.2 Management and Assessment All patients diagnosed with aSAH were treated with the antivasospastic agent nimodipine after admission. World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and modified Fisher (mFisher) scores were obtained based on the patients’ neurologic function tests and imaging at the time of admission. The presence of cerebral ischemia and hydrocephalus was assessed using the patient's pre-discharge cranial CT imaging and clinical presentation. We evaluated clinical status using the modified Rankin Scale (mRS) at 3-month after discharge (Neurosurgeons followed up with patients via telephone or an outpatient appointment). Poor functional outcome was defined as mRS ≥ 2. Dead patients were also categorized as having mRS ≥ 2. 2.3 Statistical analysis Statistical analyses were performed using SPSS version 27 (IBM, Armonk, New York, USA). Values of P < 0.05 were considered statistically significant. Continuous variables were described as mean ± standard deviation (SD) and median with interquar- tile range (IQR), and count variables as incidence (percentage). Continuous variables were tested by Student’s t test and Mann-Whitney test. All risk factors with P < 0.05 in the univariate analysis were included in the multifactorial logistic regression analysis to identify independent risk factors associated with unfavorable 3-month outcomes. Associations were expressed as odds ratios (OR) and 95% confidence intervals (CI). 3. Results 3.1 Patient Characteristics A total of 682 patients diagnosed with aSAH were reviewed in this study. Five patients aged < 18 years were excluded, nine patients with receiving only conservative treatment were excluded, and three patients with missing clinical data were excluded. A predominantly female population (63.8%) of 665 patients with a mean age of 57.8 ± 11.1 years (range, 22–92 years) was included in this study. And the mean age of female patients was significantly higher than that of males (Table 1 ). More than half of the patients had comorbid hypertension. Approximately one-third of the patients were smokers and one-fifth were alcohol drinkers, a large proportion of whom were male. Aneurysms originated mainly in the ACA (92.0%). 63% of the patients underwent intervention and 37% underwent craniotomy treatment. Patients had predominantly low World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and mFisher score. DCI occurred in about a quarter of the patients and hydrocephalus in 11.6%. The mortality rate at discharge was 5.1%, and the incidence of 3-month unfavorable outcome (mRS ≥ 2) was 31.7%. There is no significant difference between the sexes in these variables. Table 1 Characteristics of patients and comparison of sex differences before propensity score matching Parameter Total (n = 665) Female (n = 424) Male (n = 241) P Age(mean ± SD) 57.8 ± 11.1 59.3 ± 10.9 55.1 ± 10.9 < 0.001 * Comorbidities Hypertension 361 (54.3%) 232 (54.7%) 129 (53.5%) 0.767 Diabetes 51 (7.7%) 36 (8.5%) 15 (6.2%) 0.291 Smoking 221 (33.2%) 68 (16%) 153 (63.5%) < 0.001 * Drinking 134 (20.2%) 23 (5.4%) 111 (46.1%) < 0.001 * Aneurysm location 0.121 PCA 53 (8.0%) 39 (9.2%) 14 (5.8%) ACA 612 (92.0%) 385 (90.8%) 227 (94.2%) Maximum diameter of aneurysm a (IQR) 3.85 (3.00–5.00) 3.81 (3.00–5.00) 4.00 (2.70–5.20) 0.874 Treatment 0.100 Intervention 419 (63.0%) 277 (65.3%) 142 (58.9%) Craniotomy 246 (37%) 147 (34.7%) 99 (41.1%) WFNS 0.140 Ⅰ-Ⅲ 478 (71.9%) 313 (73.8%) 165 (68.5%) Ⅳ-Ⅴ 187 (28.1%) 111 (26.2%) 76 (31.5%) Hunt Hess 0.386 Ⅰ-Ⅲ 528 (79.4%) 342 (80.4%) 187 (77.6%) Ⅳ-Ⅴ 137 (20.6%) 83 (19.6%) 54 (22.4%) mFisher 0.489 0–2 489 (73.5%) 308 (72.6%) 181 (75.1%) 3–4 176 (26.5%) 116 (27.4%) 60 (24.9%) Complications DCI 172 (25.9%) 112 (26.4%) 60 (24.9%) 0.667 Hydrocephalus 77 (11.6%) 49 (11.6%) 28 (11.6%) 0.981 Mortality 34 (5.1%) 21 (5.0%) 13 (5.4%) 0.804 mRS ≥ 2 211 (31.7%) 135 (31.8%) 76 (31.5%) 0.935 PCA, posterior circulation artery; ACA, anterior circulation arterial; DCI, delayed cerebral ischemia; mRS, modified Rankin Scale a Unit of measurement, mm 3.2 Sex Differences and Adjustment To adjust for differences in basic patient characteristics such as age, smoking, alcohol consumption, hypertension, diabetes mellitus, aneurysm location and diameter, treatment, WFNS grade, Hunt Hess grade, and mFisher score, we performed 1:1 propensity score matching (PSM) with a matching tolerance of 0.02. After the PSM, we compared the information during hospitalization and prognostic information between males and females. After PSM, the mean age of the patients was similar in males and females (57.6 ± 10.8 years vs. 57.8 ± 10.8 years, P = 0.878). There were no significant differences between males and females in terms of hypertension, diabetes, smoking, drinking, aneurysm location, maximum diameter of aneurysm, treatment approach, WFNS grade, Hunt Hess grade and mFisher (all P > 0.05, Table 2 ). After PSM, female patients had a higher incidence of DCI and hydrocephalus (56/141 [39.7%] vs. 37/141 [26.2%], P = 0.016; 28/141 [19.9%] vs. 17/141 [12.1%], P = 0.044, Table 2 ). Furthermore, the number of female patients with mRS score ≥ 2 at 3-month was significantly larger than that of male patients ( P < 0.001). Table 2 Characteristics of patients and comparison of sex differences after propensity score matching Parameter Total (n = 282) Female (n = 141) Male (n = 141) P value Age(mean ± SD) 57.7 ± 10.8 57.6 ± 10.8 57.8 ± 10.8 0.878 Comorbidities Hypertension 138 (48.9%) 65 (46.1%) 73 (51.8%) 0.341 Diabetes 15 (5.3%) 9 (6.4%) 6 (4.3%) 0.426 Smoking 117 (41.5%) 58 (41.1%) 59 (41.8%) 0.904 Drinking 44 (15.6%) 22 (15.6%) 6 (15.6%) 1.000 Aneurysm location 0.330 PCA 18 (6.4%) 11 (7.8%) 7 (5.0%) ACA 264 (93.6%) 130 (92.2%) 134 (95.0%) Maximum diameter of aneurysm a (IQR) 3.50 (2.95-5.00) 3.50 (3.00-4.88) 3.58 (2.50-5.00) 0.916 Treatment 0.809 Intervention 166 (58.9%) 82 (58.2%) 84 (59.6%) Craniotomy 116 (41.1%) 59 (41.8%) 57 (40.4%) WFNS 0.620 Ⅰ-Ⅲ 180 (63.8%) 88 (62.4.0%) 92 (65.2%) Ⅳ-Ⅴ 102 (36.2%) 53 (37.6%) 49 (34.8%) Hunt Hess 0.148 Ⅰ-Ⅲ 201 (71.3%) 95 (67.4%) 106 (75.2%) Ⅳ-Ⅴ 81 (28.7%) 46 (32.6%) 35 (24.8%) mFisher 0.113 0–2 202 (71.6%) 95 (67.4%) 107 (75.9%) 3–4 80 (28.4%) 46 (32.6%) 34 (24.1%) Complications DCI 93 (33.0%) 56 (39.7%) 37 (26.2%) 0.016 * Hydrocephalus 45 (16%) 28 (19.9%) 17 (12.1%) 0.044 * Mortality 24 (8.5%) 14 (9.9%) 10 (7.1%) 0.393 mRS ≥ 2 82 (29.1%) 54 (38.3%) 28 (19.9%) < 0.001 * 3.3 Risk Factors of Poor Prognosis The results of univariate and multivariate analyses of 3-month unfavorable outcomes in patients with aSAH are shown in Table 3 . Univariate analysis of 665 patients with aSAH showed that age, WFNS grade, Hunt Hess grade, mFisher score, DCI, and hydrocephalus influenced the prognosis of patients at 3-month after discharge. Multivariate analysis logistic regression analysis showed that age (OR = 1.03, 95% CI = 1.005–1.049, P = 0.016), high Hunt Hess grade (Ⅳ-Ⅴ) (OR = 4.889, 95% CI = 2.153–11.105, P < 0.001), high mFisher score (3–4) (OR = 1.673, 95% CI = 1.006–2.784, P = 0.047), DCI (OR = 4.784, 95% CI = 2.977–7.689, P < 0.001), and hydrocephalus (OR = 16.322, 95% CI = 7.009–38.009, P < 0.001) were independent risk factors for poor patients prognosis at 3-month. Table 3 Univariate and multivariate logistic regression analysis of patients with poor prognosis before propensity adjustment Parameter Univariate multivariate OR (95%CI) P value OR (95%CI) P value Age 1.028 (1.028–1.044) < 0.001 * 1.03 (1.005–1.049) 0.016 * Female 1.014 (0.722–1.425) 0.935 1.29 (0.734–2.256) 0.378 Comorbidities Hypertension 1.085 (0.710–2.367 0.928 1.25 (0.789–1.982) 0.342 Diabetes 1.562 (0.872–2.799) 0.134 1.04 (0.432–1.199) 0.130 Smoking 1.363 (0.907–2.441) 0.313 1.45 (0.792–2.665) 0.227 Drinking 1.078 (0.443–2.044) 0.708 1.17 (0.581–2.370) 0.656 Aneurysm location ACA 1.086 (0.853–2.221) 0.505 1.16 (0.493–2.724) 0.735 Maximum diameter of aneurysm 1.276 (1.083–1.620) 0.731 1.093 (0.886–1.114) 0.908 Treatment Intervention 1.068 (0.649–1.174) 0.773 1.01 (0.627–1.630) 0.965 WFNS Ⅳ-Ⅴ 7.617 (5.229–11.095) < 0.001 * 1.551 (0.735–3.276) 0.25 Hunt Hess Ⅳ-Ⅴ 12.400 (7.943–19.357) < 0.001 * 4.889 (2.153–11.105) < 0.001 * mFisher 3–4 4.328 (3.005–6.234) < 0.001 * 1.673 (1.006–2.784) 0.047 * Complications DCI 4.613 (3.191–6.669) < 0.001 * 4.784 (2.977–7.689) < 0.001 * Hydrocephalus 23.512 (11.441–48.318) < 0.001 * 16.322 (7.009–38.009) < 0.001 * After PSM, the results of univariate analysis for 3-month unfavorable outcomes showed that age, sex, smoking, drinking, WFNS grade, Hunt Hess grade, mFisher score, DCI, and hydrocephalus influenced patients' prognosis at 3 months after discharge (Table 4 ). Multivariate analysis logistic regression analysis showed that age (OR = 1.068, 95% CI = 1.028–1.110, P < 0.001), sex (OR = 5.789, 95% CI = 2.510-13.352, P < 0.001), smoking (OR = 1.939, 95% CI = 0.966–3.316, P < 0.001), high Hunt Hess grade (Ⅳ-Ⅴ) (OR = 4.980, 95% CI = 1.196–20.737, P = 0.027), high mFisher score (3–4) (OR = 3.012, 95% CI = 0.429–21.150, P = 0.029), DCI (OR = 4.284, 95% CI = 1.901–9.657, P < 0.001), and hydrocephalus (OR = 23.340, 95% CI = 2.859-190.512, P < 0.001) were independent risk factors for poor prognosis at 3 months after discharge. Table 4 Univariate and multivariate logistic regression analysis of patients with poor prognosis after propensity adjustment Parameter Univariate multivariate OR (95%CI) P value OR (95%CI) P value Age 1.030 (1.007–1.053) 0.011 * 1.068 (1.028–1.110) < 0.001 * Female 3.114 (1.916–5.062) < 0.001 * 5.789 (2.510-13.352) < 0.001 * Comorbidities Hypertension 1.671 (1.073–2.904) 0.096 1.721 (1.022–3.334) 0.196 Diabetes 1.534 (0.531–4.430) 0.429 2.577 (0.318–20.871) 0.375 Smoking 1.693 (1.015–3.325) < 0.001 * 1.939 (0.966–3.316) < 0.001 * Drinking 1.317 (1.156–2.645) 0.002 * 1.112 (1.060–2.727) 0.064 Aneurysm location ACA 1.094 (0.587–1.516) 0.509 1.377 (0.154–2.631) 0.325 Maximum diameter of aneurysm 1.208 (0.993–2.875) 0.110 1.663 (1.070–3.411) 0.092 Treatment Intervention 1.067 (1.002–1.641) 0.433 1.312 (0.981–4.204) 0.757 WFNS Ⅳ-Ⅴ 9.189 (5.102–16.549) < 0.001 * 2.255 (0.637–7.980) 0.207 Hunt Hess Ⅳ-Ⅴ 13.287 (6.449–27.374) < 0.001 * 4.980 (1.196–20.737) 0.027 * mFisher 3–4 5.363 (2.955–9.733) < 0.001 * 3.012 (0.429–21.150 0.029 * Complications DCI 3.716 (2.178–6.339) < 0.001 * 4.284(1.901–9.657) < 0.001 * Hydrocephalus 63.505 (8.604-468.751) < 0.001 * 23.340 (2.859-190.512) 0.003 * 4. Discussion This was a large, single-center, observational retrospective study that involved 665 patients with a clinical diagnosis of aSAH from April 2020 to January 2022. In addition, strict inclusion and exclusion criteria were established to ensure comparability of data and credibility of results. Women (424/665, 63.8%) were more vulnerable to have aSAH compared to men, and women were older. In our study, after adjusting for age, hypertension, diabetes, smoking, drinking, location and size of ruptured aneurysm, WFNS grade, Hunt Hess grade, mFS score, and treatment approach, the results showed that females were more likely to have DCI, with a higher incidence of poor prognosis at 3 months after discharge. In our study, females were approximately twice as likely as males to have a ruptured aneurysm, which is consistent with previous studies [ 5 , 12 ] . In 665 patients with aSAH, our study found no significant difference in prognosis between male and female [ 7 ] . However, the age difference between female and male patients may lead to a comparison bias between the two groups. In addition, the different basic characteristics of aneurysms, comorbidities and treatment approaches in female and male patients may have an influence on the comparison between the two groups [ 13 ] . However, in our study, the ratio of female patients with mRS score ≥ 2 was significantly higher than that of male patients after adjusting for age, aneurysm characteristics, comorbidities, WNFS grade, Hunt Hess grade, mFisher score, and treatment approach. It has been shown that DCI and hydrocephalus are two critical complications that affect the prognosis of aSAH [ 14 ] . After PSM, our study found that the incidence of DCI was significantly higher in female aSAH patients than in male patients, consistent with other studies [ 3 , 15 – 17 ] . The poor prognosis of females with aSAH may be due to the fact that females are more prone to vasospasm [ 18 ] . Studies have shown that early vasospasm predicts a higher incidence of cerebral ischemia associated with subarachnoid hemorrhage and a poorer prognosis [ 19 ] . Women have been reported to be an independent risk factor for cerebral vasospasm after aSAH [ 20 , 21 ] . In addition, catecholamine metabolites reflecting sympathetic excitation have been found to have higher levels in the cerebrospinal fluid of female patients with SAH, which also suggests that they are more prone to vasospasm [ 22 ] . Moreover, estrogen may play a protective role in vascular system mainly through its influence on the proliferation and migration of vascular smooth muscle cells [ 23 ] . Therefore, because of the decrease of estrogen in postmenopausal women, the role of vascular smooth muscle cells in the vascular system in the physiological and pathological process is affected to a certain extent. This may be a factor in the poor prognosis of some women with ruptured aneurysms, especially those near or past menopause. However, the role and mechanism of estrogen in subarachnoid hemorrhage diseases still need to be further studied. Furthermore, sharp and abrupt decreases in estradiol concentrations during menopause, combined with genetic predisposition and environmental factors, may disrupt cerebrovascular homeostasis [ 24 ] . Increased hemodynamics and oxidative stress may trigger an inflammatory cascade response leading to macrophage, neutrophil, and chemotactic infiltrates that promote chronic inflammation in cerebral arteries. These changes lead to vessel wall degeneration, focal weakening, and cerebral arterial wall ectasia, ultimately leading to aneurysm formation and rupture, thus making postmenopausal women more susceptible to aneurysm rupture leading to aSAH [ 24 ] . In addition, after PSM, female patients with aSAH were more vulnerable to hydrocephalus than male patients in our study. Experimental studies in rats have shown that females have a higher risk of hydrocephalus after SAH [ 25 ] . In addition, clinical studies have found that females have a high risk of developing hydrocephalus after aSAH [ 26 , 27 ] . This sex difference may be related to the role of estrogen in maintaining vascular integrity by reducing oxidative stress [ 24 ] . In addition, women have higher concentrations of norepinephrine and dopamine metabolites in the cerebrospinal fluid compared to men, therefore women are at a higher risk of developing hydrocephalus [ 22 ] . However, reports have shown no finding that female patients with aSAH are more vulnerable to hydrocephalus [ 17 ] . Besides confirming that female sex is independent risk factors for poor prognosis after ASAH, our results showed that age, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus are independent risk factors of poor prognosis [ 18 ] . We observed that high Hunt Hess grade, high mFisher score were more common in women whereas smoking was more frequent in men. In our study, older age was also an independent risk factor for poor prognosis, which is consistent with other studies [ 28 , 29 ] . We reviewed clinical and imaging records and included only confirmed first-time ruptured intracranial aneurysm cases. Our study found that females were more likely to have aSAH and that females were an independent risk factor for poor prognosis, which may be related to the fact that females are more vulnerable to DCI and hydrocephalus. However, the reasons and mechanisms for this sex difference and whether it is related to estrogen remain unclear [ 30 , 31 ] . Therefore, a rapid diagnosis and amelioration of DCI and hydrocephalus is important to improve the prognosis of patients with aSAH, especially in women, who have a higher morbidity. Most studies show that the average size of a ruptured aneurysm is less than 7 mm [ 32 ] . Post-rupture thrombosis of the aneurysm lumen may explain why the diameter of many of the ruptured aneurysms in our series was relatively small. An additional factor that has biased our study cohort towards smaller ruptured aneurysms, is the fact that the higher cost of treating larger ruptured aneurysms led to earlier retrieval of care for many of the patients with larger aneurysms. We hope to address this bias in our future studies. It’s worth mentioning that in our research, the proportion of patients with a history of alcohol consumption was high (134/665, 20.2%), and about 5:1 between men and women with a history of alcohol consumption, which may be related to the habits formed by the cold climate of the region. In this study, in order to exclude the influence of other factors and only consider the effect of gender on the prognosis of aSAH, we matched the propensity scores of hypertensions, diabetes, smoking and drinking in different genders, so we did not investigate the effect of drinking history on the prognosis of SAH. We did not have separate statistics on the effect of alcohol consumption on prognosis. However, it does not mean that alcohol consumption has no effect on aSAH prognosis. Some studies have shown that the patient proportion of alcohol consumption was dramatically greater in males than that in females [ 33 ] . Patients with alcohol consumption are at higher odds of angiographic vasospasm and delayed cerebral ischemia, which are related to poor prognosis following aSAH [ 33 ] . It remains to be further explored whether alcohol consumption has a significant impact on the prognosis of patients with aSAH by sex. In addition, the relationship between the location of the aneurysm and non-dominant hemispheres is crucial to the prognosis of the patient. Considering that the number of cases in this study is not enough, there are only 141 patients in each group after PSM. If divided according to the location of aneurysms and the non-dominant hemispheres, the number of patients who can be matched after PSM will be very small, which may affect the conclusion. In the next step, we will collect as many cases as possible, further classify the location of the aneurysm, and take into account the important factors such as the location of the aneurysm and the non-dominant hemisphere. In addition, smoking has a dose-dependent and cumulative association with SAH risk [ 34 ] , whereas smoking was not quantified in our study. Declarations Ethics approval This study was approved by the Ethics Committee of the General Hospital of Northern Theater Command. All processes were performed in accordance with the Declaration of Helsinki and local ethical policies. Informed consent was obtained from all subjects and/or their legal guardians. Consent to participate Not available Consent for publication Not available Funding None Competing interests All authors declare no competing interests. Availability of data and material Data on the results of this study are available from the corresponding authors on reasonable request. Code availability Not available Authors’ contributions Yuwei Han: research idea and conception, performing, data acquisition, data analysis and manuscript writing; Bingying Zhang: data acquisition, data analysis; Xin Qi, data acquisition; Guanqian Yuan: research idea; Guobiao Liang: research idea, conception and reviewing; Xiaoming Li: research idea, conception and reviewing; Guangzhi Hao, conception and reviewing Acknowledgements We appreciate the support of the General Hospital of Northern Theater Command for this study. 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Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus. Front Neurol 2022; 13:1014501. Germans MR, Jaja BNR, de Oliviera Manoel AL, Cohen AH, Macdonald RL. Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage. J Neurosurg 2018; 129(2):458-464. Macdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol 2014; 10(1):44-58. Rehman S, Phan HT, Chandra RV, Gall S. Is sex a predictor for delayed cerebral ischaemia (DCI) and hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH)? A systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165(1):199-210. Zuurbier CCM, Molenberg R, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, et al. Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis. Stroke 2022; 53(2):362-369. Al-Mufti F, Roh D, Lahiri S, Meyers E, Witsch J, Frey HP, et al. Ultra-early angiographic vasospasm associated with delayed cerebral ischemia and infarction following aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 126(5):1545-1551. Darkwah Oppong M, Iannaccone A, Gembruch O, Pierscianek D, Chihi M, Dammann P, et al. Vasospasm-related complications after subarachnoid hemorrhage: the role of patients' age and sex. Acta Neurochir (Wien) 2018; 160(7):1393-1400. Lai PMR, Gormley WB, Patel N, Frerichs KU, Aziz-Sultan MA, Du R. Age-Dependent Radiographic Vasospasm and Delayed Cerebral Ischemia in Women After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 130:e230-e235. Lambert G, Naredi S, Eden E, Rydenhag B, Friberg P. Monoamine metabolism and sympathetic nervous activation following subarachnoid haemorrhage: influence of gender and hydrocephalus. Brain Res Bull 2002; 58(1):77-82. Dehaini H, Fardoun M, Abou-Saleh H, El-Yazbi A, Eid AA, Eid AH. Estrogen in vascular smooth muscle cells: A friend or a foe? Vascul Pharmacol 2018; 111:15-21. Ramesh SS, Christopher R, Indira Devi B, Bhat DI. The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage. Biol Rev Camb Philos Soc 2019; 94(6):1897-1917. Shishido H, Zhang H, Okubo S, Hua Y, Keep RF, Xi G. The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage. Acta Neurochir Suppl 2016; 121:335-339. Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 1999; 45(5):1120-1127; discussion 1127-1128. Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52(4):763-769; discussion 769-771. Galea JP, Dulhanty L, Patel HC, Uk, Ireland Subarachnoid Hemorrhage Database C. Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients: Observations From a Multicenter Data Set. Stroke 2017; 48(11):2958-2963. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007; 38(8):2315-2321. Desai M, Wali AR, Birk HS, Santiago-Dieppa DR, Khalessi AA. Role of pregnancy and female sex steroids on aneurysm formation, growth, and rupture: a systematic review of the literature. Neurosurg Focus 2019; 47(1):E8. Demel SL, Kittner S, Ley SH, McDermott M, Rexrode KM. Stroke Risk Factors Unique to Women. Stroke 2018; 49(3):518-523. Waqas M, Chin F, Rajabzadeh-Oghaz H, Gong AD, Rai HH, Mokin M, et al. Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162(6):1353-1362. Zhao L, Cheng C, Peng L, Zuo W, Xiong D, Zhang L, et al. Alcohol Abuse Associated With Increased Risk of Angiographic Vasospasm and Delayed Cerebral Ischemia in Patients With Aneurysmal Subarachnoid Hemorrhage Requiring Mechanical Ventilation. Front Cardiovasc Med 2022; 9:825890. Etminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, et al. Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76(5):588-597. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 May, 2024 Read the published version in BMC Neurology → Version 1 posted Editorial decision: Revision requested 18 Mar, 2024 Reviews received at journal 17 Mar, 2024 Reviewers agreed at journal 17 Mar, 2024 Reviews received at journal 20 Feb, 2024 Reviewers agreed at journal 20 Feb, 2024 Reviewers invited by journal 14 Feb, 2024 Editor invited by journal 14 Feb, 2024 Editor assigned by journal 14 Feb, 2024 Submission checks completed at journal 14 Feb, 2024 First submitted to journal 09 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3942408","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272911028,"identity":"89373612-7bf8-4df7-976a-c0f811167654","order_by":0,"name":"Yuwei Han","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yuwei","middleName":"","lastName":"Han","suffix":""},{"id":272911029,"identity":"93433059-df54-4f6c-abe4-2e9c13a0c501","order_by":1,"name":"Bingying Zhang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Bingying","middleName":"","lastName":"Zhang","suffix":""},{"id":272911030,"identity":"bfd09276-c627-4848-a4f4-6c61da0a1fc1","order_by":2,"name":"Xin Qi","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Qi","suffix":""},{"id":272911031,"identity":"cc890fb0-1bd5-4288-9de5-ceab3ca55ff1","order_by":3,"name":"Guanqian Yuan","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Guanqian","middleName":"","lastName":"Yuan","suffix":""},{"id":272911032,"identity":"dbf71f37-43fc-4740-8f39-9aaf287f2189","order_by":4,"name":"Guobiao Liang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Guobiao","middleName":"","lastName":"Liang","suffix":""},{"id":272911033,"identity":"73887eea-914d-4ea7-98f4-683f80b90749","order_by":5,"name":"Xiaoming Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACPgYG9g8fKmyAVGPjgw/EaGEDIsYZZ9IYGHgONxvOIFYLM2fLYQYGifQ2aQ6itEhkpz1mbEizN7j5sEGagcFOTreBkBaes9uNC3fYJG64ndhgXMCQbGx2gJAW9t4N0jPPpCWYAbUkz2A4kLiNoBZm3g3SvG2H7c1uHmw4zEOUFvbebSAtjNtuMDY2E6eF5+xmQ2AgJ+4/k9jMOMOACL/wS+RufACMSnvJ9uPPf3yosJMjqAUNGJCmfBSMglEwCkYBDgAAX3JGzrSblDIAAAAASUVORK5CYII=","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":true,"prefix":"","firstName":"Xiaoming","middleName":"","lastName":"Li","suffix":""},{"id":272911034,"identity":"18191d7b-76a3-406a-8b7d-9dd3a69dc017","order_by":6,"name":"Guangzhi Hao","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Guangzhi","middleName":"","lastName":"Hao","suffix":""}],"badges":[],"createdAt":"2024-02-09 08:15:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3942408/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3942408/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-024-03659-3","type":"published","date":"2024-05-04T19:58:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56042923,"identity":"41712f6d-9eea-4e66-a411-ae54b3625f6f","added_by":"auto","created_at":"2024-05-07 20:09:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":876899,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3942408/v1/300cbd14-8f31-4c31-856b-0f1b71358a2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAneurysmal subarachnoid hemorrhage (aSAH) is more prevalent in women than in men compared with other types of stroke\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Several studies have shown that females are associated with a poorer prognosis after aSAH compared to males\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Others have reported that sex is not a prognostic factor for aSAH prognosis\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Thus, it remains controversial whether outcomes following aSAH differ between men and women.\u003c/p\u003e \u003cp\u003eAneurysmal characteristics and complications including delayed cerebral ischemia (DCI) and hydrocephalus are the most important factors responsible for the poor prognosis of aSAH\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Several studies have shown that these factors may contribute to the sex differences in poor prognosis of aSAH. Other studies have reported sex differences in the site and location of ruptured aneurysms\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, this study retrospectively analyzed the clinical data of aSAH patients treated at our institution. The aim of this study was to investigate sex differences in the aneurysm characteristics, complications and 3-month prognosis.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u0026rsquo; material collection and variables\u003c/h2\u003e \u003cp\u003e This was a retrospective study, and all protocols were approved by the Ethics Committee of the General Hospital of Northern Theater Command, which was approved on 10 March 2023. Patients diagnosed with aSAH at the Neurosurgery Department of the General Hospital of Northern Theater Command from April 2020 to January 2022 were collected. All data analyses were performed in accordance with the Declaration of Helsinki and local ethical policies. And all patients were treated and managed according to guidelines.\u003c/p\u003e \u003cp\u003eAll patients were diagnosed with aSAH by computed tomography angiography (CTA) or digital subtraction angiography (DSA), and the location and number of aneurysms were clarified. If the patient had multiple intracranial aneurysms, the ruptured aneurysm was recorded as the responsible aneurysm. In this study, we have reviewed in detail information on the basic characteristics of patients, smoking and drinking, aneurysm characteristics, treatment approaches, and comorbidities. Aneurysms originating from various segments of the vertebral and basilar arteries and their branching aneurysms were recorded as posterior circulation artery (PCA) aneurysms. Aneurysms originating from the internal carotid artery, anterior and middle cerebral and their branching aneurysms were anterior circulation arterial (ACA) aneurysms.In this study, the treatment of all patients was categorized into intervention and craniotomy. Intervention mainly consisted of coil embolization and flow direction. Patients who underwent clipping or bypass were categorized as craniotomies.\u003c/p\u003e \u003cp\u003eWe set inclusion criteria including (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) no history of ruptured aneurysm; (3) patients who underwent only craniotomy and intervention therapy; and (4) time from rupture to admission not exceeding 72 h, and time from admission to treatment not exceeding 72 h. To ensure the accuracy of the analysis, we excluded: (1) other neurological diseases (tumors, vascular malformations, Parkinson's disease) and functional or neurological deficits of the extremities from any cause; (2) history of neurosurgery prior to the rupture; (3) treatment with external ventricular drainage, lumbar puncture, angiography, intubation and/or mechanical ventilation in other hospitals prior to the visit to our clinic; (4) anemia on admission (hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;120 g/L for male and \u0026lt;\u0026thinsp;110 g/L for female); (5) receiving or have received hormonal replacement therapy and (6) missing clinical data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Management and Assessment\u003c/h2\u003e \u003cp\u003eAll patients diagnosed with aSAH were treated with the antivasospastic agent nimodipine after admission. World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and modified Fisher (mFisher) scores were obtained based on the patients\u0026rsquo; neurologic function tests and imaging at the time of admission. The presence of cerebral ischemia and hydrocephalus was assessed using the patient's pre-discharge cranial CT imaging and clinical presentation. We evaluated clinical status using the modified Rankin Scale (mRS) at 3-month after discharge (Neurosurgeons followed up with patients via telephone or an outpatient appointment). Poor functional outcome was defined as mRS\u0026thinsp;\u0026ge;\u0026thinsp;2. Dead patients were also categorized as having mRS\u0026thinsp;\u0026ge;\u0026thinsp;2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 27 (IBM, Armonk, New York, USA). Values of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. Continuous variables were described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and median with interquar-\u003c/p\u003e \u003cp\u003etile range (IQR), and count variables as incidence (percentage). Continuous variables were tested by Student\u0026rsquo;s t test and Mann-Whitney test. All risk factors with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis were included in the multifactorial logistic regression analysis to identify independent risk factors associated with unfavorable 3-month outcomes. Associations were expressed as odds ratios (OR) and 95% confidence intervals (CI).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 682 patients diagnosed with aSAH were reviewed in this study. Five patients aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years were excluded, nine patients with receiving only conservative treatment were excluded, and three patients with missing clinical data were excluded. A predominantly female population (63.8%) of 665 patients with a mean age of 57.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1 years (range, 22\u0026ndash;92 years) was included in this study. And the mean age of female patients was significantly higher than that of males (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). More than half of the patients had comorbid hypertension. Approximately one-third of the patients were smokers and one-fifth were alcohol drinkers, a large proportion of whom were male. Aneurysms originated mainly in the ACA (92.0%). 63% of the patients underwent intervention and 37% underwent craniotomy treatment. Patients had predominantly low World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and mFisher score. DCI occurred in about a quarter of the patients and hydrocephalus in 11.6%. The mortality rate at discharge was 5.1%, and the incidence of 3-month unfavorable outcome (mRS\u0026thinsp;\u0026ge;\u0026thinsp;2) was 31.7%. There is no significant difference between the sexes in these variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of patients and comparison of sex differences before propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;665)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;424)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;241)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e232 (54.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221 (33.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (63.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111 (46.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAneurysm location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e612 (92.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e385 (90.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227 (94.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum diameter of aneurysm\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e(IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.85 (3.00\u0026ndash;5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.81 (3.00\u0026ndash;5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.00 (2.70\u0026ndash;5.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e419 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWFNS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ-Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e478 (71.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e313 (73.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165 (68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHunt Hess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ-Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e528 (79.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e342 (80.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003emFisher\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e489 (73.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308 (72.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e181 (75.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emRS\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePCA, posterior circulation artery; ACA, anterior circulation arterial; DCI, delayed cerebral ischemia; mRS, modified Rankin Scale\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Unit of measurement, mm\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Sex Differences and Adjustment\u003c/h2\u003e \u003cp\u003eTo adjust for differences in basic patient characteristics such as age, smoking, alcohol consumption, hypertension, diabetes mellitus, aneurysm location and diameter, treatment, WFNS grade, Hunt Hess grade, and mFisher score, we performed 1:1 propensity score matching (PSM) with a matching tolerance of 0.02. After the PSM, we compared the information during hospitalization and prognostic information between males and females.\u003c/p\u003e \u003cp\u003eAfter PSM, the mean age of the patients was similar in males and females (57.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years vs. 57.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.878). There were no significant differences between males and females in terms of hypertension, diabetes, smoking, drinking, aneurysm location, maximum diameter of aneurysm, treatment approach, WFNS grade, Hunt Hess grade and mFisher (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After PSM, female patients had a higher incidence of DCI and hydrocephalus (56/141 [39.7%] vs. 37/141 [26.2%], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016; 28/141 [19.9%] vs. 17/141 [12.1%], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Furthermore, the number of female patients with mRS score\u0026thinsp;\u0026ge;\u0026thinsp;2 at 3-month was significantly larger than that of male patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of patients and comparison of sex differences after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;282)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138 (48.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (46.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAneurysm location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (92.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum diameter of aneurysm\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e(IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.50 (2.95-5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.50 (3.00-4.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.58 (2.50-5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWFNS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ-Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (62.4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHunt Hess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ-Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (75.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (24.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003emFisher\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 (71.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.044\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emRS\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Risk Factors of Poor Prognosis\u003c/h2\u003e \u003cp\u003eThe results of univariate and multivariate analyses of 3-month unfavorable outcomes in patients with aSAH are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Univariate analysis of 665 patients with aSAH showed that age, WFNS grade, Hunt Hess grade, mFisher score, DCI, and hydrocephalus influenced the prognosis of patients at 3-month after discharge. Multivariate analysis logistic regression analysis showed that age (OR\u0026thinsp;=\u0026thinsp;1.03, 95% CI\u0026thinsp;=\u0026thinsp;1.005\u0026ndash;1.049, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), high Hunt Hess grade (Ⅳ-Ⅴ) (OR\u0026thinsp;=\u0026thinsp;4.889, 95% CI\u0026thinsp;=\u0026thinsp;2.153\u0026ndash;11.105, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), high mFisher score (3\u0026ndash;4) (OR\u0026thinsp;=\u0026thinsp;1.673, 95% CI\u0026thinsp;=\u0026thinsp;1.006\u0026ndash;2.784, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047), DCI (OR\u0026thinsp;=\u0026thinsp;4.784, 95% CI\u0026thinsp;=\u0026thinsp;2.977\u0026ndash;7.689, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and hydrocephalus (OR\u0026thinsp;=\u0026thinsp;16.322, 95% CI\u0026thinsp;=\u0026thinsp;7.009\u0026ndash;38.009, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent risk factors for poor patients prognosis at 3-month.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis of patients with poor prognosis before propensity adjustment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003emultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.028 (1.028\u0026ndash;1.044)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03 (1.005\u0026ndash;1.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.014 (0.722\u0026ndash;1.425)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29 (0.734\u0026ndash;2.256)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.085 (0.710\u0026ndash;2.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25 (0.789\u0026ndash;1.982)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.562 (0.872\u0026ndash;2.799)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04 (0.432\u0026ndash;1.199)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.363 (0.907\u0026ndash;2.441)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.45 (0.792\u0026ndash;2.665)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.078 (0.443\u0026ndash;2.044)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17 (0.581\u0026ndash;2.370)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAneurysm location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.086 (0.853\u0026ndash;2.221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.16 (0.493\u0026ndash;2.724)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum diameter of aneurysm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.276 (1.083\u0026ndash;1.620)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.093 (0.886\u0026ndash;1.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.068 (0.649\u0026ndash;1.174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01 (0.627\u0026ndash;1.630)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWFNS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.617 (5.229\u0026ndash;11.095)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.551 (0.735\u0026ndash;3.276)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHunt Hess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.400 (7.943\u0026ndash;19.357)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.889 (2.153\u0026ndash;11.105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003emFisher\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.328 (3.005\u0026ndash;6.234)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.673 (1.006\u0026ndash;2.784)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.613 (3.191\u0026ndash;6.669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.784 (2.977\u0026ndash;7.689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.512 (11.441\u0026ndash;48.318)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.322 (7.009\u0026ndash;38.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter PSM, the results of univariate analysis for 3-month unfavorable outcomes showed that age, sex, smoking, drinking, WFNS grade, Hunt Hess grade, mFisher score, DCI, and hydrocephalus influenced patients' prognosis at 3 months after discharge (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Multivariate analysis logistic regression analysis showed that age (OR\u0026thinsp;=\u0026thinsp;1.068, 95% CI\u0026thinsp;=\u0026thinsp;1.028\u0026ndash;1.110, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), sex (OR\u0026thinsp;=\u0026thinsp;5.789, 95% CI\u0026thinsp;=\u0026thinsp;2.510-13.352, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), smoking (OR\u0026thinsp;=\u0026thinsp;1.939, 95% CI\u0026thinsp;=\u0026thinsp;0.966\u0026ndash;3.316, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), high Hunt Hess grade (Ⅳ-Ⅴ) (OR\u0026thinsp;=\u0026thinsp;4.980, 95% CI\u0026thinsp;=\u0026thinsp;1.196\u0026ndash;20.737, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027), high mFisher score (3\u0026ndash;4) (OR\u0026thinsp;=\u0026thinsp;3.012, 95% CI\u0026thinsp;=\u0026thinsp;0.429\u0026ndash;21.150, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029), DCI (OR\u0026thinsp;=\u0026thinsp;4.284, 95% CI\u0026thinsp;=\u0026thinsp;1.901\u0026ndash;9.657, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and hydrocephalus (OR\u0026thinsp;=\u0026thinsp;23.340, 95% CI\u0026thinsp;=\u0026thinsp;2.859-190.512, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent risk factors for poor prognosis at 3 months after discharge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis of patients with poor prognosis after propensity adjustment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003emultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.030 (1.007\u0026ndash;1.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.068 (1.028\u0026ndash;1.110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.114 (1.916\u0026ndash;5.062)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.789 (2.510-13.352)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.671 (1.073\u0026ndash;2.904)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.721 (1.022\u0026ndash;3.334)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.534 (0.531\u0026ndash;4.430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.577 (0.318\u0026ndash;20.871)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.693 (1.015\u0026ndash;3.325)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.939 (0.966\u0026ndash;3.316)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.317 (1.156\u0026ndash;2.645)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.112 (1.060\u0026ndash;2.727)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAneurysm location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.094 (0.587\u0026ndash;1.516)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.377 (0.154\u0026ndash;2.631)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum diameter of aneurysm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.208 (0.993\u0026ndash;2.875)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.663 (1.070\u0026ndash;3.411)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.067 (1.002\u0026ndash;1.641)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.312 (0.981\u0026ndash;4.204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWFNS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.189 (5.102\u0026ndash;16.549)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.255 (0.637\u0026ndash;7.980)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHunt Hess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ-Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.287 (6.449\u0026ndash;27.374)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.980 (1.196\u0026ndash;20.737)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003emFisher\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.363 (2.955\u0026ndash;9.733)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.012 (0.429\u0026ndash;21.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.716 (2.178\u0026ndash;6.339)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.284(1.901\u0026ndash;9.657)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.505 (8.604-468.751)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.340 (2.859-190.512)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis was a large, single-center, observational retrospective study that involved 665 patients with a clinical diagnosis of aSAH from April 2020 to January 2022. In addition, strict inclusion and exclusion criteria were established to ensure comparability of data and credibility of results. Women (424/665, 63.8%) were more vulnerable to have aSAH compared to men, and women were older. In our study, after adjusting for age, hypertension, diabetes, smoking, drinking, location and size of ruptured aneurysm, WFNS grade, Hunt Hess grade, mFS score, and treatment approach, the results showed that females were more likely to have DCI, with a higher incidence of poor prognosis at 3 months after discharge. In our study, females were approximately twice as likely as males to have a ruptured aneurysm, which is consistent with previous studies\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn 665 patients with aSAH, our study found no significant difference in prognosis between male and female\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. However, the age difference between female and male patients may lead to a comparison bias between the two groups. In addition, the different basic characteristics of aneurysms, comorbidities and treatment approaches in female and male patients may have an influence on the comparison between the two groups\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. However, in our study, the ratio of female patients with mRS score\u0026thinsp;\u0026ge;\u0026thinsp;2 was significantly higher than that of male patients after adjusting for age, aneurysm characteristics, comorbidities, WNFS grade, Hunt Hess grade, mFisher score, and treatment approach.\u003c/p\u003e \u003cp\u003eIt has been shown that DCI and hydrocephalus are two critical complications that affect the prognosis of aSAH\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. After PSM, our study found that the incidence of DCI was significantly higher in female aSAH patients than in male patients, consistent with other studies\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The poor prognosis of females with aSAH may be due to the fact that females are more prone to vasospasm\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that early vasospasm predicts a higher incidence of cerebral ischemia associated with subarachnoid hemorrhage and a poorer prognosis\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Women have been reported to be an independent risk factor for cerebral vasospasm after aSAH\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. In addition, catecholamine metabolites reflecting sympathetic excitation have been found to have higher levels in the cerebrospinal fluid of female patients with SAH, which also suggests that they are more prone to vasospasm\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Moreover, estrogen may play a protective role in vascular system mainly through its influence on the proliferation and migration of vascular smooth muscle cells\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Therefore, because of the decrease of estrogen in postmenopausal women, the role of vascular smooth muscle cells in the vascular system in the physiological and pathological process is affected to a certain extent. This may be a factor in the poor prognosis of some women with ruptured aneurysms, especially those near or past menopause. However, the role and mechanism of estrogen in subarachnoid hemorrhage diseases still need to be further studied.\u003c/p\u003e \u003cp\u003eFurthermore, sharp and abrupt decreases in estradiol concentrations during menopause, combined with genetic predisposition and environmental factors, may disrupt cerebrovascular homeostasis\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Increased hemodynamics and oxidative stress may trigger an inflammatory cascade response leading to macrophage, neutrophil, and chemotactic infiltrates that promote chronic inflammation in cerebral arteries. These changes lead to vessel wall degeneration, focal weakening, and cerebral arterial wall ectasia, ultimately leading to aneurysm formation and rupture, thus making postmenopausal women more susceptible to aneurysm rupture leading to aSAH\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, after PSM, female patients with aSAH were more vulnerable to hydrocephalus than male patients in our study. Experimental studies in rats have shown that females have a higher risk of hydrocephalus after SAH\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In addition, clinical studies have found that females have a high risk of developing hydrocephalus after aSAH\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. This sex difference may be related to the role of estrogen in maintaining vascular integrity by reducing oxidative stress\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. In addition, women have higher concentrations of norepinephrine and dopamine metabolites in the cerebrospinal fluid compared to men, therefore women are at a higher risk of developing hydrocephalus\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, reports have shown no finding that female patients with aSAH are more vulnerable to hydrocephalus\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBesides confirming that female sex is independent risk factors for poor prognosis after ASAH, our results showed that age, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus are independent risk factors of poor prognosis\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. We observed that high Hunt Hess grade, high mFisher score were more common in women whereas smoking was more frequent in men. In our study, older age was also an independent risk factor for poor prognosis, which is consistent with other studies\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe reviewed clinical and imaging records and included only confirmed first-time ruptured intracranial aneurysm cases. Our study found that females were more likely to have aSAH and that females were an independent risk factor for poor prognosis, which may be related to the fact that females are more vulnerable to DCI and hydrocephalus. However, the reasons and mechanisms for this sex difference and whether it is related to estrogen remain unclear\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Therefore, a rapid diagnosis and amelioration of DCI and hydrocephalus is important to improve the prognosis of patients with aSAH, especially in women, who have a higher morbidity.\u003c/p\u003e \u003cp\u003eMost studies show that the average size of a ruptured aneurysm is less than 7 mm\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Post-rupture thrombosis of the aneurysm lumen may explain why the diameter of many of the ruptured aneurysms in our series was relatively small. An additional factor that has biased our study cohort towards smaller ruptured aneurysms, is the fact that the higher cost of treating larger ruptured aneurysms led to earlier retrieval of care for many of the patients with larger aneurysms. We hope to address this bias in our future studies.\u003c/p\u003e \u003cp\u003eIt\u0026rsquo;s worth mentioning that in our research, the proportion of patients with a history of alcohol consumption was high (134/665, 20.2%), and about 5:1 between men and women with a history of alcohol consumption, which may be related to the habits formed by the cold climate of the region. In this study, in order to exclude the influence of other factors and only consider the effect of gender on the prognosis of aSAH, we matched the propensity scores of hypertensions, diabetes, smoking and drinking in different genders, so we did not investigate the effect of drinking history on the prognosis of SAH. We did not have separate statistics on the effect of alcohol consumption on prognosis. However, it does not mean that alcohol consumption has no effect on aSAH prognosis. Some studies have shown that the patient proportion of alcohol consumption was dramatically greater in males than that in females\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Patients with alcohol consumption are at higher odds of angiographic vasospasm and delayed cerebral ischemia, which are related to poor prognosis following aSAH\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. It remains to be further explored whether alcohol consumption has a significant impact on the prognosis of patients with aSAH by sex. In addition, the relationship between the location of the aneurysm and non-dominant hemispheres is crucial to the prognosis of the patient. Considering that the number of cases in this study is not enough, there are only 141 patients in each group after PSM. If divided according to the location of aneurysms and the non-dominant hemispheres, the number of patients who can be matched after PSM will be very small, which may affect the conclusion. In the next step, we will collect as many cases as possible, further classify the location of the aneurysm, and take into account the important factors such as the location of the aneurysm and the non-dominant hemisphere. In addition, smoking has a dose-dependent and cumulative association with SAH risk\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, whereas smoking was not quantified in our study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the General Hospital of Northern Theater Command. All processes were performed in accordance with the Declaration of Helsinki and local ethical policies. Informed consent was obtained from all subjects and/or their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData on the results of this study are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYuwei Han: research idea and conception, performing, data acquisition, data analysis and manuscript writing; Bingying Zhang: data acquisition, data analysis; Xin Qi, data acquisition; Guanqian Yuan: research idea; Guobiao Liang: research idea, conception and reviewing; Xiaoming Li: research idea, conception and reviewing; Guangzhi Hao, conception and reviewing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate the support of the General Hospital of Northern Theater Command for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNichols L, Stirling C, Otahal P, Stankovich J, Gall S. Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27(3):660-668.\u003c/li\u003e\n\u003cli\u003eWang YX, He J, Zhang L, Li Y, Zhao L, Liu H, et al. A higher aneurysmal subarachnoid hemorrhage incidence in women prior to menopause: a retrospective analysis of 4,895 cases from eight hospitals in China. Quant Imaging Med Surg 2016; 6(2):151-156.\u003c/li\u003e\n\u003cli\u003eRehman S, Chandra RV, Zhou K, Tan D, Lai L, Asadi H, et al. Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome. Acta Neurochir (Wien) 2020; 162(9):2271-2282.\u003c/li\u003e\n\u003cli\u003eBogli SY, Utebay D, Smits N, Westphal LP, Hirsbrunner L, Unseld S, et al. Sex-related differences of invasive therapy in patients with aneurysmal subarachnoid hemorrhage. 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Clin Neurol Neurosurg 2017; 157:82-87.\u003c/li\u003e\n\u003cli\u003eAlshekhlee A, Mehta S, Edgell RC, Vora N, Feen E, Mohammadi A, et al. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke 2010; 41(7):1471-1476.\u003c/li\u003e\n\u003cli\u003eWang L, Zhang Q, Zhang G, Zhang W, Chen W, Hou F, et al. Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus. Front Neurol 2022; 13:1014501.\u003c/li\u003e\n\u003cli\u003eGermans MR, Jaja BNR, de Oliviera Manoel AL, Cohen AH, Macdonald RL. Sex differences in delayed cerebral ischemia after subarachnoid hemorrhage. J Neurosurg 2018; 129(2):458-464.\u003c/li\u003e\n\u003cli\u003eMacdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol 2014; 10(1):44-58.\u003c/li\u003e\n\u003cli\u003eRehman S, Phan HT, Chandra RV, Gall S. Is sex a predictor for delayed cerebral ischaemia (DCI) and hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH)? A systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165(1):199-210.\u003c/li\u003e\n\u003cli\u003eZuurbier CCM, Molenberg R, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, et al. Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis. Stroke 2022; 53(2):362-369.\u003c/li\u003e\n\u003cli\u003eAl-Mufti F, Roh D, Lahiri S, Meyers E, Witsch J, Frey HP, et al. Ultra-early angiographic vasospasm associated with delayed cerebral ischemia and infarction following aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 126(5):1545-1551.\u003c/li\u003e\n\u003cli\u003eDarkwah Oppong M, Iannaccone A, Gembruch O, Pierscianek D, Chihi M, Dammann P, et al. Vasospasm-related complications after subarachnoid hemorrhage: the role of patients\u0026apos; age and sex. Acta Neurochir (Wien) 2018; 160(7):1393-1400.\u003c/li\u003e\n\u003cli\u003eLai PMR, Gormley WB, Patel N, Frerichs KU, Aziz-Sultan MA, Du R. Age-Dependent Radiographic Vasospasm and Delayed Cerebral Ischemia in Women After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 130:e230-e235.\u003c/li\u003e\n\u003cli\u003eLambert G, Naredi S, Eden E, Rydenhag B, Friberg P. Monoamine metabolism and sympathetic nervous activation following subarachnoid haemorrhage: influence of gender and hydrocephalus. Brain Res Bull 2002; 58(1):77-82.\u003c/li\u003e\n\u003cli\u003eDehaini H, Fardoun M, Abou-Saleh H, El-Yazbi A, Eid AA, Eid AH. Estrogen in vascular smooth muscle cells: A friend or a foe? Vascul Pharmacol 2018; 111:15-21.\u003c/li\u003e\n\u003cli\u003eRamesh SS, Christopher R, Indira Devi B, Bhat DI. The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage. Biol Rev Camb Philos Soc 2019; 94(6):1897-1917.\u003c/li\u003e\n\u003cli\u003eShishido H, Zhang H, Okubo S, Hua Y, Keep RF, Xi G. The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage. Acta Neurochir Suppl 2016; 121:335-339.\u003c/li\u003e\n\u003cli\u003eSheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 1999; 45(5):1120-1127; discussion 1127-1128.\u003c/li\u003e\n\u003cli\u003eDorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52(4):763-769; discussion 769-771.\u003c/li\u003e\n\u003cli\u003eGalea JP, Dulhanty L, Patel HC, Uk, Ireland Subarachnoid Hemorrhage Database C. Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients: Observations From a Multicenter Data Set. Stroke 2017; 48(11):2958-2963.\u003c/li\u003e\n\u003cli\u003eRosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007; 38(8):2315-2321.\u003c/li\u003e\n\u003cli\u003eDesai M, Wali AR, Birk HS, Santiago-Dieppa DR, Khalessi AA. Role of pregnancy and female sex steroids on aneurysm formation, growth, and rupture: a systematic review of the literature. Neurosurg Focus 2019; 47(1):E8.\u003c/li\u003e\n\u003cli\u003eDemel SL, Kittner S, Ley SH, McDermott M, Rexrode KM. Stroke Risk Factors Unique to Women. Stroke 2018; 49(3):518-523.\u003c/li\u003e\n\u003cli\u003eWaqas M, Chin F, Rajabzadeh-Oghaz H, Gong AD, Rai HH, Mokin M, et al. Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162(6):1353-1362.\u003c/li\u003e\n\u003cli\u003eZhao L, Cheng C, Peng L, Zuo W, Xiong D, Zhang L, et al. Alcohol Abuse Associated With Increased Risk of Angiographic Vasospasm and Delayed Cerebral Ischemia in Patients With Aneurysmal Subarachnoid Hemorrhage Requiring Mechanical Ventilation. Front Cardiovasc Med 2022; 9:825890.\u003c/li\u003e\n\u003cli\u003eEtminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, et al. Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76(5):588-597.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aneurysmal subarachnoid hemorrhage, female, propensity score matching, outcome","lastPublishedDoi":"10.21203/rs.3.rs-3942408/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3942408/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSex differences in outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. Therefore, the aim of this study was to investigate the sex differences in the prognosis of patients with aSAH.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e This study retrospectively analyzed the clinical data of aSAH patients admitted to the Department of Neurosurgery of General Hospital of Northern Theater Command, from April 2020 to January 2022. The modified Rankin Scale (mRS) was used to evaluate outcomes at 3-month post-discharge. Baseline characteristics, in-hospital complications and outcomes were compared after 1:1 propensity score matching (PSM).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 665 patients were included and the majority (63.8%) were female. Female patients were significantly older than male patients (59.3 ± 10.9 years vs. 55.1 ± 10.9 years, \u003cem\u003eP \u0026lt;\u003c/em\u003e 0.001). After PSM, 141 male and 141 female patients were compared. Comparing postoperative complications and mRS scores, the incidence of delayed cerebral ischemia (DCI) and hydrocephalus and mRS ≥ 2 at 3-month were significantly higher in female patients than in male patients. After adjustment, the analysis of risk factors for unfavorable prognosis at 3-month showed that age, sex, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus were independent risk factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Female patients with aSAH have a worse prognosis than male patients, and this difference may be because females are more vulnerable to DCI and hydrocephalus.\u003c/p\u003e","manuscriptTitle":"Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-15 17:41:20","doi":"10.21203/rs.3.rs-3942408/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-18T07:48:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-17T10:08:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13deb433-b189-40e5-b0fb-e23c78a9911f","date":"2024-03-17T09:26:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-20T10:57:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d0808710-ff41-487a-ac85-c3a033d5f4d1","date":"2024-02-20T08:39:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-14T21:16:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-14T20:54:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-14T09:22:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-14T09:22:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2024-02-09T08:13:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c968c12f-1399-40ee-b181-b48590e77fa7","owner":[],"postedDate":"February 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-07T20:05:33+00:00","versionOfRecord":{"articleIdentity":"rs-3942408","link":"https://doi.org/10.1186/s12883-024-03659-3","journal":{"identity":"bmc-neurology","isVorOnly":false,"title":"BMC Neurology"},"publishedOn":"2024-05-04 19:58:43","publishedOnDateReadable":"May 4th, 2024"},"versionCreatedAt":"2024-02-15 17:41:20","video":"","vorDoi":"10.1186/s12883-024-03659-3","vorDoiUrl":"https://doi.org/10.1186/s12883-024-03659-3","workflowStages":[]},"version":"v1","identity":"rs-3942408","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3942408","identity":"rs-3942408","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}