Sex Differences in Prognosis of Childhood Arterial Ischemic Stroke: Results from Chinese Pediatric Ischemic Stroke Registry Multicenter Registry.

BackgroundCurrent studies on the impact of sex in the prognosis of childhood arterial ischemic stroke (AIS) are limited. We aimed to explore the sex differences on outcomes in childhood AIS patients.MethodsA retrospective analysis was conducted using the prospective data from the Chinese Pediatric Ischemic Stroke Registry (CPISR). Baseline characteristics between sexes were compared in the total population cohort, propensity score (PS)-matched cohort and inverse probability of treatment weighting (IPTW) cohort. Multivariate logistic regression and ordinal regression were used to analyze the association of sex with outcomes. Mixed-effects regression model was applied to further analyze the improvement in pediatric modified Rankin Scale (mRS) scores between sexes from 90 days to 1 year. Survival analysis was used to estimate the recurrence rates during the follow-up period.ResultsA total of 468 patients (58.1% males) were finally included. Multivariate logistic regression showed that there were no significant differences between females and males in achieving favorable outcome (pediatric mRS 0-2) (OR 1.04, 95% CI 0.63-1.72), functional independence (pediatric mRS 0-1) (OR 0.98, 95% CI 0.59-1.63), or shift to worse pediatric mRS scores (OR 0.83, 95% CI 0.59-1.17) at 90 days after index stroke. After propensity score matching (PSM), 324 patients (50.0% males) were analyzed, confirming the same results regarding favorable outcome (OR 0.82, 95% CI 0.54-1.47), functional independence (OR 0.68, 95% CI 0.37-1.22), and shift pediatric mRS (OR 0.95, 95% CI 0.64-1.42). The results of mixed-effects regression and survival analysis indicated that females and males exhibited comparable functional recovery from 90 days to 1 year and had similar recurrent risk during the median 12.6 months follow-up period.ConclusionsThis nationally-representative observational study indicated that both males and females pediatric AIS patients exhibited comparable similar clinical outcomes at 90 days, as well as similar improvements and risks of recurrence during the follow-up period.