Abstract Body: Objective: We sought to investigate the consequences of alcohol intake on intracerebral hemorrhage (ICH) and cerebral small vessel disease (cSVD) in patients with spontaneous ICH.
Methods: We compared markers of cSVD [Figure 1], features of ICH, and outcomes among consecutive spontaneous ICH patients with different alcohol use strata admitted to a tertiary care center between 2003-2019. Alcohol intake was categorized as none/mild (<5 drinks/week), moderate/severe (5 drinks/week-5 drinks/day), and heavy (>5 drinks/day). We performed descriptive statistics and bivariate/multivariate analyses based on demographic and radiologic data.
Results: We included 1590 patients (53% male, median age 74 years [IQR 64-82]). Among them, 82.6% had none/mild alcohol intake, 14.2% moderate/severe, and 3.3% heavy alcohol intake. Heavy alcohol users were 13 years younger at time of ICH than none/mild users (median [IQR], 62 [57-70] vs 75 [65-83], p<0.0001). Heavy alcohol users were more likely to have deep ICHs (60% vs 45%, p=0.037), larger median ICH volumes (30 vs 15mL, p=0.025), and lower platelet counts (195/µL vs 225/µL, p=0.049). MRI analysis showed that heavy alcohol users had similar degree of cSVD as none/mild users, even though they were much younger. In separate regression models heavy alcohol use was independently associated with younger age at the time of ICH (p=0.004) and higher ICH volume (p=0.007). There was no significant difference in in-hospital mortality between the two groups (31% vs 42%, p=0.1).
The moderate/severe users were 5 years younger at the time of ICH compared to none/mild alcohol users (p<0.0001). There was no significant difference in ICH location, volume, or platelet counts between the groups. In-hospital mortality was lower in the moderate/severe group (23% vs 42%, p<0.0001). None/mild alcohol use was independently associated with more severe leukoaraiosis (p<0.0001) and higher case fatality (p<0.0001) compared to moderate/severe use in separate multivariable models.
Conclusion: Heavy alcohol use is strongly associated with an earlier ICH risk (median age difference of 13 years) and larger ICH volumes compared to none/mild alcohol use, relationships that might be explained by alcohol-related hypocoagulable state. Despite being much younger, heavy drinkers have similar cSVD burden compared to none/mild users. Moderate/severe alcohol consumption did not display clear negative effects on ICH- or cSVD-related characteristics or short-term outcomes.