The Association of Alcohol and Tobacco Use with Baseline Platelet and Neutrophil Counts in Patients with Non-traumatic Intracerebral Hemorrhage

Introduction: Non-traumatic Intracerebral Hemorrhage (ICH) accounts for 2 of 15 million strokes globally each year. Inflammatory responses triggered by hematoma components can exacerbate damage within the affected parenchyma. Several modifiable risk factors for stroke may be associated with certain peripheral biomarkers. Studies have shown reduced platelet and increased leukocytes in tobacco and alcohol users. Higher neutrophils upon ICH admission were associated with poor outcomes at 30 days. Assessment of peripheral biomarkers of inflammation and hemostasis in patients with modifiable risk factors such as smoking, and alcohol use may help identify mechanisms involved in the ICH-induced injury and disease course.

Methods: We retrospectively reviewed charts of 96 patients with non-traumatic ICH from 2019-2021. Patient characteristics such as smoking and alcohol use, in addition to baseline platelet and leukocyte counts, were extracted. Independent sample T-tests were used to investigate differences in mean platelet and neutrophil counts between smokers/non-smokers and heavy alcohol users/non-alcohol users.

Results: Of the 96 patients, 64 were moderate to heavy alcohol users and 61 were smokers. Mean platelet count +/- SEM was 224.1+/- 16.5 in current alcoholics and 241.45 +/- 13.8 in non-alcoholics (p=0.49). Mean neutrophil count was 7.7+/- 0.6 in alcoholics and 6.6 +/- 0.4 in non-alcoholics (p=0.17). Mean platelet count in current smokers was 229.34 +/- 26.7 vs 243.38 +/- 11.7 in non-smokers (p=0.62). Mean neutrophil count was 7.6 in both smokers, +/- 1.2 and non-smokers, +/- 0.5 (p=0.97).

Conclusion : This pilot study demonstrates no significant difference in platelet counts nor neutrophils in current alcohol users and smokers. However, there is a trend towards lower platelets and neutrophils in this population. Given that an appropriate inflammatory and hemostatic response is required for hematoma resolution, the preliminary trend may allude to an underlying mechanism by which tobacco and alcohol use contribute to poor outcomes post ICH and should be further studied.