Abstract P692: This is Your Brain on Drugs: The Burden and Severity of Stroke Related to Substance Use and Infective Endocarditis

Abstract

Background: Substance abuse is a major health crisis in the US, with approximately 20 million people suffering from substance use disorders (SUD). The rate of opioid-related overdose deaths in Kentucky has climbrf from 1.3 per 100,000 persons in 1999 to a staggering 23.6 in 2016. SUD is a risk factor for infectious endocarditis (IE), an important cause of stroke in young patients. We previously reported that SUD in stroke is associated with poorer admission NIH stroke scales and longer lengths of stay (LOS) compared to patients without SUD. Objective: To describe the burden of stroke due to endocarditis in a regional population within Kentucky, and to compare outcomes of stroke in patients with SUD with or without evidence of IE. Methods: This is a single center, retrospective chart review of patients with SUD and stroke. Subjects included adults age > 18 years, who received the diagnosis of acute stroke, and were identified as an illicit drug user based on either urine drug testing or provided history in the medical record, admitted between October 2015 and May 2019. Data elements collected included length of stay (LOS), admission/discharge NIH stroke scale scores, drug use history, laboratory data, discharge modified Rankin Scores, intracerebral hemorrhage (ICH) scores, and discharge status. Results: We identified 197 (M=157, 74.6%) SUD/IE-, and 116 (M=81, 69.8%) SUD/IE+ stroke cases. SUD+/IE+ cases were younger with a mean age of 36.53 +/- 8.94, as compared to SUD+/IE-, mean age of 54.94 +/-12.01 (p<0.0001). Ischemic stroke was more common than ICH in both groups. While admission NIHSS scores were similar in the two groups, SUD+/IE+ patients had longer lengths of stay (29.60 +/-25.73 days vs. 11.65 +/-16.95, p<0.0001), and experienced greater mortality, with 38 deaths (32.8% SUD+/IE+) as compared to 20 (10.2%) in the SUD+/IE- group, p<0.0001. An additional 16 (13.8%) patients IE+ were discharged to hospice, compared to 8 (4.1%) in the IE- group, p=0.003. Conclusion: Within our regional population, there is a high burden of SUD-related infective endocarditis and stroke, which is associated with poorer outcomes and increased mortality. Further study is warranted to examine the socioeconomic factors influencing SUD in our population to reduce overall disease burden.