1074. Effect of Cigarette Smoking on Functional Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

Authors: Natasha Ironside, MbChB; Ching-Jen Chen, MD; Josephine Pucci, BA; Edward Connolly, Jr., MD (Rockville, MD)

Introduction: Nicotine may exert a neuroprotective effect on the injured brain through modulation of the cholinergic anti-inflammatory pathway. The aim of this study was to evaluate the relationship between cigarette smoking and outcomes in patients enrolled in the Intracerebral Hemorrhage Outcomes Project (ICHOP). Methods: From January 2009 – November 2017, consenting adult patients (aged ³ 18 years) admitted to the Columbia University Medical Center Neurological Intensive Care Unit with spontaneous intracerebral haemorrhage (ICH), were prospectively enrolled in ICHOP. Smoking patterns were categorised as recent smoker (cigarette use £30 days prior to ICH) and not recent smoker (cigarette use >30 days prior to ICH). The primary outcome was good functional outcome (90 day modified Rankin Scale [mRS] £2. Secondary outcomes were excellent functional outcome (90 day mRS 0-1), 90-day Barthel Index, in-hospital mortality and 90-day mortality. Results: Of 716 enrolled patients, 545 had sufficient data for inclusion, comprising 60 recent smokers and 485 not recent smokers. Univariable logistic regression comparisons revealed recent smoking status to be associated with increased odds of good (OR=1.787 [1.009, 3.165]; p=0.047) and excellent (OR=2.220 [1.168, 4.221) p=0.015) functional outcome. This did not remain significant in the multivariable model (adjusted OR 1.019 [0.517, 2.008]; p=0.956 and (adjusted OR=1.131 [0.526, 2.431] p=0.752 for good and excellent outcome, respectively). In-hospital mortality, Barthel Index and mortality at 90-days did not differ between the groups. Conclusion: Cigarette smoking does not appear to be associated with decreased odds of 90-day good or excellent functional outcome and may, in fact, be associated with trends towards improved functional outcomes in patients with spontaneous ICH. Differences in clinical risk profiles existed among patients with various smoking status presenting with ICH. Therefore, the potential neuroprotective effects of nicotine may be outweighed by the detrimental effects of smoking on health outcomes.