Abstract TP196: Ischemic Stroke With Large Vessel Occlusion and Systemic Acidosis: Associations With Functional Outcomes and Mortality

Abstract

Introduction: Systemic acidosis is common in critical conditions, including severe myocardial infarction, renal and liver injuries, and traumatic brain injury. However, the potential connection between ischemic stroke involving large vessel occlusion (LVO) and acidosis has not been extensively explored. With this study we aimed to assess the prevalence of respiratory and metabolic acidosis in ischemic stroke with LVO and their potential links to functional outcomes and mortality. Methods: Retrospective single center cohort of patients with ischemic stroke and LVO status post endovascular thrombectomy. Univariate logistic regression was used to examine the relationship between acidosis on admission and (1) hospital mortality and (2) 90-day modified Rankin Scale (mRS) dichotomized as unfavorable (>3) vs favorable (≤3). In addition, we investigated association with acidosis and symptomatic ICH. Metabolic acidosis was defined by the presence of one of the following: Serum bicarbonate <22 mEq/L, lactic acid >2 mmol/L or pH <7.35. Respiratory acidosis was defined by pCO2 >45 mmHg. Results: There was a total of 346 patients, average age was 68.5 (±15) years, 169 (49%) were females. 168 (49%) patients were acidotic on admission, 4 (1%) had respiratory acidosis, 7 (2%) had mixed acidosis and the remaining 157 (45%) had metabolic acidosis. There was no statistically significant association between systemic acidosis with either hospital mortality (p=0.31]) or 90-day favorable functional outcome (p=0.23]). There was no association between acidosis with symptomatic ICH (p=0.47). Conclusion: In our retrospective cohort study, we observed that approximately half of the patients with stroke and LVO had systemic acidosis. Unlike other critical neurological conditions like traumatic brain injury, we did not identify a substantial correlation between systemic acidosis and either mortality or the functional outcome at the 90-day mark. Given the high prevalence of acidosis in patients with LVO, larger multi-center studies are needed to further investigate its association with the outcomes and mortality.