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Factors associated with progression and sex-specific patterns in chronic subdural hematoma: a single-centre

Weijian Yang1,2,3,4,5, Zhuoying Du1,2,3,4,5, Qifang Chen1,2,3,4,6

  • 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Frontiers in Neurology
|December 22, 2025
PubMed

Insights

Chronic subdural hematoma (CSDH) progression is linked to elevated INR, hypertension, diabetes, NLR, WBC, and maximum hematoma density. Female sex appears protective against CSDH progression, warranting further investigation.

Area of Science:

  • Neurosurgery
  • Neurology
  • Internal Medicine

Background:

  • Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in elderly patients.
  • Understanding the factors influencing CSDH progression is crucial for effective management and treatment strategies.
  • Potential sex-related differences in CSDH development and progression remain an area of active research.

Purpose of the Study:

  • To identify independent predictors of chronic subdural hematoma (CSDH) progression.
  • To investigate potential sex-specific differences in factors associated with CSDH progression.
  • To develop a better understanding of the pathophysiology of CSDH.

Main Methods:

  • Retrospective analysis of 1,142 patients with unilateral CSDH.
  • Data collection included demographics, clinical characteristics, hematoma density, and hematological parameters.
  • Multivariable logistic regression and cohort analysis were employed to identify independent predictors of progression.

Main Results:

  • Independent risk factors for CSDH progression included elevated international normalized ratio (INR), hypertension, diabetes, neutrophil-to-lymphocyte ratio (NLR), white blood cell count (WBC), and maximum hematoma density (MaHD).
  • Female gender was identified as a significant protective factor against CSDH progression.
  • Subgroup analysis revealed sex-specific differences in hemoglobin, serum albumin, and platelet counts, though values remained within normal ranges.

Conclusions:

  • Elevated INR, hypertension, diabetes, NLR, WBC, and MaHD are independently associated with CSDH progression.
  • Female sex demonstrates a protective effect against CSDH progression.
  • Prospective validation of these findings is necessary to confirm their clinical significance.
Abstract

Keywords:
chronic subdural hematomacoagulationinflammationprogressionsex

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