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Wednesday, September 12, 2012

Heavy alcohol intake and intracerebral hemorrhage Characteristics and effect on outcome

To identify associated factors and influence on long-term outcome of heavy alcohol intake in a large prospective cohort of consecutive patients with a spontaneous intracerebral hemorrhage (ICH).

Between November 2004 and March 2009, we prospectively recruited 562 consecutive adults with a spontaneous ICH. We excluded patients without information on drinking habit (n = 22). Heavy alcohol intake was defined as a regular consumption of more than 300 g alcohol/week. We performed bivariate and multivariate analyses (logistic regression) based on demographic and radiologic models. Survival analyses were performed using Kaplan-Meier statistics.

Among 540 patients with ICH, 137 (25) were heavy alcohol drinkers (median age 60 vs 74 years in nonabusers; p < 0.0001). In the multivariate demographic model, heavy alcohol drinkers were less likely to be older (odds ratio [OR] 0.97 per 1-year increase, 95% confidence interval [CI] 0.95−0.98) and to have a history of ischemic heart disease (OR 0.34, 95% CI 0.15−0.77) and more likely to be smokers (OR 3.96, 95% CI 2.43−6.46). In the radiologic model, independent factors were nonlobar location of ICH (OR 1.71, 95% CI 1.05−2.77) and less severe leukoaraiosis (OR 0.76 per 1-step increase, 95%CI 0.62−0.73). Platelet counts and prothrombin ratio were significantly lower among heavy alcohol drinkers (respectively, p = 0.01 and p = 0.017). Heavy alcohol intake was predictive of 2 years mortality only among patients younger than 60 years with nonlobar ICH (hazard ratio 1.96, 95% CI 1.06−3.63).

Heavy alcohol intake is associated with the occurrence of ICH at a young age. However, the underlying vasculopathy remains unexplored in these patients. Indirect markers suggest small-vessel disease at an early stage that might be enhanced by moderate hemostatic disorders.

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