Impact of acute alcohol intoxication and alcohol dependence on outcomes after subarachnoid hemorrhage

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-08-27 DOI:10.1007/s00701-025-06639-9

Isaac B. Thorman, Ankita Jain, Elad Mashiach, Ariel Sacknovitz, Eris Spirollari, Rachid Kaddoura, Ruaa Alsaeed, Michael C. Schubert, Uchenna N. Okafo, Jon B. Rosenberg, Pankajavalli Ramakrishnan, Stephan A. Mayer, Chirag D. Gandhi, Fawaz Al-Mufti

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Abstract

Background

Non-traumatic subarachnoid hemorrhage (SAH) is most commonly caused by a ruptured aneurysm. Risk factors for rupture include hypertension, smoking, and substance use, but the relationship between alcohol use and clinical outcomes after SAH is poorly understood. The objective of this population-based, longitudinal, study is to characterize the relationships between alcohol use, alcohol dependence, and adverse clinical outcomes following SAH.

Methods

Patients with alcohol use disorder (International Classification of Disease 10th Revision Diagnostic Code F10) in the TriNetX Research Network were compared to patients with no substance use disorders (None of F10-F19). Short-term (30-day) outcomes were assessed among patients with blood alcohol concentrations tested on the day of SAH. Outcome frequencies and Cox proportional hazard models used propensity score matching on demographics, comorbidities, blood counts, substance use, and SAH severity.

Results

We identified 216,894 patients with non-traumatic SAH. Of these, 11,648 were tested for alcohol and 27,079 patients had alcohol use disorder. Blood alcohol levels of 1–100 mg/dL and above at the time of SAH were associated with decreased 30-day mortality in acute alcohol use compared to 0 mg/dL, and alcohol concentrations of 201–300 mg/dL and higher were further protective relative to 1–100 mg/dL. Patients with alcohol use disorder exhibited an increased hazard of mortality (HR = 1.175 [95% CI: 1.129, 1.223]; p < 0.0001) compared to patients with no substance use disorders (n = 151,377). Patients with severe alcohol dependence had an even higher hazard of mortality compared to patients with mild/moderate use disorder (HR = 1.139 [1.128, 1.150] p < 0.0001).

Conclusions

In patients with non-traumatic SAH, alcohol in the blood at the time of SAH is protective against 30-day mortality, and increased alcohol concentration adds increased protection. Paradoxically, alcohol use disorder leads to a worsening of clinical outcomes, including mortality. There appears to be a significant dose-dependent effect of severity of alcohol dependence on mortality.

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急性酒精中毒和酒精依赖对蛛网膜下腔出血后预后的影响

背景：非创伤性蛛网膜下腔出血（SAH）最常由动脉瘤破裂引起。破裂的危险因素包括高血压、吸烟和药物使用，但酒精使用与SAH后临床结果之间的关系尚不清楚。这项以人群为基础的纵向研究的目的是确定酒精使用、酒精依赖和SAH后不良临床结果之间的关系。方法将TriNetX研究网络中的酒精使用障碍患者（国际疾病分类第十版诊断代码F10）与无物质使用障碍患者（F10- f19均无）进行比较。在SAH当日检测血液酒精浓度的患者中评估短期（30天）结果。结果频率和Cox比例风险模型使用倾向评分匹配人口统计学、合并症、血细胞计数、物质使用和SAH严重程度。结果共发现216,894例非创伤性SAH患者。其中，11,648人接受了酒精检测，27,079人患有酒精使用障碍。与0 mg/dL相比，急性饮酒时1-100 mg/dL及以上的血液酒精浓度与30天死亡率降低相关，201-300 mg/dL及以上的酒精浓度相对于1-100 mg/dL具有进一步的保护作用。与没有物质使用障碍的患者（n = 151,377）相比，酒精使用障碍患者的死亡风险增加（HR = 1.175 [95% CI: 1.129, 1.223]; p < 0.0001）。重度酒精依赖患者的死亡风险甚至高于轻度/中度使用障碍患者（HR = 1.139 [1.128, 1.150] p < 0.0001）。结论在非创伤性SAH患者中，SAH发生时血液中的酒精对30天死亡率具有保护作用，且酒精浓度的增加增加了保护作用。矛盾的是，酒精使用障碍会导致临床结果的恶化，包括死亡率。酒精依赖严重程度对死亡率似乎存在显著的剂量依赖性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.