Elevated Blood Alcohol Concentration at Stroke Onset Predicts Poor Clinical Outcomes and Mortality After...

The impact of acute alcohol consumption at the onset of spontaneous non-traumatic intracerebral hemorrhage (ICH) remains unclear. We evaluated the association between elevated blood alcohol concentration (BAC) at admission and clinical outcomes in patients with ICH.

This retrospective single-center cohort study analyzed 1081 patients admitted with ICH between 2000 and 2023. BAC was measured at admission when alcohol use was suspected. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Outcomes-7-day neurological deterioration (ND), mortality, 90-day modified Rankin Scale (mRS) scores-were analyzed using logistic and Cox regression models to assess associations with acute alcohol consumption.

Patients that were BAC positive (alcohol group; n = 31, 2.9%) were younger, predominantly male, had larger hematoma volumes, showed significantly higher rates of 7-day ND (58.1% vs. 27.6%, p < 0.001) and mortality at 7, 30, and 90 days (51.6% vs. 23.7%, 71% vs. 37.6%, 71% vs. 43.3%, all p < 0.001) than patients with no clinical suspicion of alcohol consumption (control group; n = 1050, 97.1%). Multivariable Cox regression identified elevated BAC as an independent predictor of mortality at all time points (HR 2.089, 95% CI 1.091-3.997, p = 0.026 at 7 days; HR 2.133, 95% CI 1.220-3.728, p = 0.008 at 30 days; HR 2.096, 95% CI 1.214-3.622, p = 0.008 at 90 days). Multivariate logistic regression identified elevated BAC as an independent predictor of 7-day ND (OR 4.188, 95% CI 1.163-15.078, p = 0.028) and large ICH volume (≥ 30 cm³) (OR 3.67, 95% CI 1.388-9.704, p = 0.009). In a subgroup analysis of heavy-drinking patients, elevated BAC was associated with early ND, increased mortality, and large ICH volume.

Elevated BAC at ICH onset independently predicts early ND and increased mortality, indicating a potentially modifiable prognostic factor in acute ICH. These results underscore the importance of BAC measurement in patients with suspected alcohol consumption and warrant further research aimed at understanding and mitigating its potential detrimental effects.