[Neurology] Heavy alcohol intake and intracerebral hemorrhage: Characteristics and effect on outcome

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Primer: Heavy alcohol consumption has long been considered a risk factor for intracranial hemorrhage (ICH), yet there exists little research regarding the effect of excessive alcohol intake on the characteristics and outcomes of spontaneous ICH. The authors of this article conducted a large prospective cohort study to answer two important questions:

• How do ICH characteristics differ in those with heavy alcohol consumption compared to those without?
• How does alcohol intake influence short and long term outcomes in patients who suffer spontaneous ICH?

This [prospective cohort] study: Over 5 years, demographic, clinical, and radiologic data as well alcohol intake and medical histories were collected for 540 patients admitted to the Lille University Hospital for acute stroke with CT evidence of parenchymal hemorrhage. Of these, 137 were classified as heavy alcohol drinkers (current and regular consumption of more than 300 g of alcohol per week). Statistical analysis comparing heavy drinkers to non-heavy drinkers revealed a few key findings:

• Heavy drinkers presented with ICH at a younger median age of 60 years (IQR: 52-69) versus non-heavy drinkers who presented at median age 74 years (IQR: 62-81) (p < 0.0001).
• In heavy drinkers, platelet count (205 million/L) and prothrombin ratio (92%) were significantly lower in compared to their non-heavy drinker counterparts (platelet ct. = 222 billion/L; prothrombin ratio = 86%).
• Patients with heavy alcohol intake were more likely to suffer a non-lobar (deep or posterior fossa) ICH (OR 1.71, CI: 1.05-2.77).
• Heavy drinkers did not experience any increase in intrahospital complications or length of hospital stay. However, in patients less than 60 years of age who suffered a non-lobar ICH, mortality was higher in those with heavy alcohol intake (HR 1.96, CI: 1.06-3.63).

In sum: This study found that among patients presenting with intracranial hemorrhage (ICH), those who consume large amounts of alcohol were more likely to be younger in age. Higher rates of ICH in non-lobar locations and increased incidence of low platelet count and low prothrombin ratio in heavy drinkers suggest that both small-vessel disease and hemostatic disorders may play a role in ICH manifestation. Finally, alcohol consumption was only predictive of mortality in a small subset of study subjects – those who were young (less than 60 years of age) and who suffered a non-lobar ICH. The authors of the study note that while these results show “alcohol has an impact on vital outcome among young patients with ICH… it remains a risk factor and not a cause itself.”

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