Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Abstract

Methamphetamine use has emerged as a risk factor for intracerebral hemorrhage (ICH). We aim to investigate the clinical characteristics and outcomes of methamphetamine-associated ICH (Meth-ICH) versus Non-Meth-ICH. Patients with ICH between January 2011 and December 2017 were studied. Meth-ICH and Non-Meth-ICH were defined by history of abuse and urine drug screen (UDS). The clinical features of the 2 groups were explored. Among the 677 consecutive patients, 61 (9.0%) were identified as Meth-ICH and 350 as Non-Meth ICH. Meth-ICH was more common in Hispanics (14.6%) and Whites (10.1%) as compared to Asians (1.2%). Patients with Meth-ICH were more often younger (51.2 vs. 62.2 years, p < 0.001), male (77.0% vs. 61.4.0%, p < 0.05), and smokers (44.3% vs. 13.4%, p < 0.001). Non-Meth-ICH was more likely to have history of hypertension (72.61% v. 59%, p < 0.05) or antithrombotic use (10.9% vs. 1.6%, p < 0.05). There was no significant difference in clinical severity, hospital length of stay (LOS), rate of functional independence (29.5% vs. 25.7%, p = 0.534), or mortality (18.0% vs. 24.6%, p = 0.267) between the 2 groups. Methamphetamine use was not an independent predictor of poor outcome. Despite difference in demographics, Meth-ICH is similar to Non-Meth ICH in hospital course and outcome. MethodsThis is a retrospective observational study. It was approved by the University of California Irvine Institutional Review Board (IRB) and the Ethics Committee. Informed consents were waived as part of the IRB approval. All methods in the study were performed in accordance with the relevant guidelines and regulations.Consecutive patients with spontaneous ICH at the University of California Irvine Comprehensive Stroke Center between January 1, 2011 and December 31, 2017 were identified by searching electronic medical records and the prospectively maintained American Heart Association (AHA)-Get With The Guidelines (GWTG)-Stroke Registry. ICH from cerebral aneurysm, arteriovenous malformation, brain tumors, coagulopathy, or trauma were excluded. Patients with Meth-ICH were identified by recorded history of methamphetamine use or a positive urine drug screen (UDS) at the time of admission. The UDS was performed using EMIT II Plus Amphetamines assay (1,000 ng/mL cutoff) with a sensitivity and specificity of 94.3% and 93.3%, respectively 21 . Those with a positive UDS while taking trazodone, Adderall, bupropion, or labetalol within 2 weeks of admission were excluded due to potential false-positive result 22 . Patients with no history of methamphetamine use and a negative UDS were included in Non-Meth-ICH group. Patients who denied history of drug abuse but had no UDS were excluded from the comparison analysis. All ICH patients were initially managed in the dedicated Neuroscience ICU with standard ICH order-set and clinical pathway by board-certified neurointensivists.The following information was abstracted from chart review and the AHA GWTG-Stroke Registry: age, gender, race, past medical history, the highest blood pressure (BP) lev...

Intracerebral hemorrhage: who gets tested for methamphetamine use and why might it matter?

“…ICH patients hospitalized in rural hospitals were found to have a lower drug abuse rate (1.2% vs 3.8%, p < 0.001) but two times the odds of dying (OR 2.07, 95% CI 1.77–2.41, p < 0.001) compared to those in urban hospitals. In our previous study [ 7 ], there was no significant difference in mortality between methamphetamine-associated versus non-methamphetamine ICH (18.0% vs. 24.6%, p = 0.267). We did not look into the rural-urban disparities in methamphetamine use and associated ICH in our single center study.…”

“…Of note, we excluded patients with documented recent use of trazodone, Adderall, bupropion, or labetalol to minimize the false positive rates [ 7 ]. However, due to lack of information on other medications that may potentially cause false-positive results [ 14 ], we were unable to calculate the true false positive rate.…”

“…Of all the substances, only methamphetamine and cocaine are significant risk factors for ICH. In our study cohort, only 2 patients were also tested positive for cocaine [ 7 ]. Other stimulants therefore were unlikely a significant confounding factor for our ICH study.…”

“…Home medications were reviewed to determine potential for false positive results [ 14 ]. Patients who was taking trazodone, Adderall, bupropion, or labetalol within 2 weeks of admission were excluded from the study to minimize false postive cases [ 7 ].…”

“…Both chronic and acute use may lead to intracerebral hemorrhage (ICH), with previous studies reporting these patients faring worse [ 4 – 6 ]. Our previous study, looking at outcomes between methamphetamine and non-methamphetamine associated ICH, revealed no difference in ICH severity, length of stay (LOS), and functional outcome, which may be attributed to dedicated care in a neurological intensive care unit (ICU), something not available at all hospitals [ 7 ]. The only treatment for methamphetamine addiction is behavioral therapy [ 2 , 8 ], highlighting the importance of early interventions to mitigate this potentially preventable, increasingly recognized risk factor for ICH [ 5 – 7 , 9 – 11 ].…”