Abstract WP445: Characteristics of Methamphetamine-Related Intracerebral Hemorrhage and Factors Associated With Outcomes

Abstract

Background and Purposes: Methamphetamine use is on the rise worldwide. There are limited data and cognizance on methamphetamine-related intracerebral hemorrhage (ICH). This study aimed to investigate the characteristics of methamphetamine-related ICH and to explore the factors associated with outcomes. Methods: This retrospective cohort study enrolled consecutive ICH patients at a comprehensive stroke center between January 2011 and December 2017. Patients with methamphetamine related ICH were included for analysis of demographics, clinical features, and outcomes at hospital discharge. Factors associated with discharge outcomes were explored using multivariate logistic regression models. Results: Among the 686 consecutive patients admitted for spontaneous ICH during the study period, 412 (60.1%) had urine toxicology tests and 60 (8.7%) were identified to have methamphetamine use per history and positive urine test. Of note, 30 patients who denied substance use had positive urine test. The mean age was 51.8 years old and 78.3% patients were male. There was significant racial disparity in methamphetamine use, with highest ratio in Hispanics (14.9%), followed by White (9.2%), African Americans (5.7%), and Asians (1.2%). The mortality rate of methamphetamine-related ICH was 18.3% and only 25.0% patients achieved functional independence at hospital discharge. NIHSS (OR=0.15; 95% CI 0.04-0.62; P=0.005), GCS (OR=0.05; 95% CI 0.01-0.43; P=0.001), ICH score (OR=0.08; 95% CI 0.01-0.67; P=0.005), smoking history (OR=6.76; 95% CI 1.82-25.00; P=0.002), surgical intervention (OR=0.13; 95% CI 0.03-0.66; P=0.007) and ventilator support (OR=0.11; 95% CI 0.02-0.56; P=0.003) were independently associated with functional status. Risk factors of mortality include NIHSS (OR=2.45; 95% CI 1.75-3.44; P<0.001), GCS (OR=3.06; 95% CI 2.05-4.59; P<0.001), ICH score (OR=4.46; 95% CI 2.65-7.52; P<0.001), creatinine level (OR=8.97; 95% CI 2.12-37.98; P=0.001) and ventilator support (OR=2.89; 95% CI 1.96-4.24; P<0.001). Conclusion: Methamphetamine use is a major cause of ICH, especially in Hispanic population. Clinical severity scores, elevated creatinine levels, and ventilator support are associated with poor outcomes at hospital discharge.