Acute Intracerebral Hemorrhage (ICH) and Systemic Acidosis: Associations with Functional Outcomes and Mortality
Alexander Andreev1, Mitchell Wilson1, Jia-Yi Wang1, Daniel Forsman1, Nadia McMillan1, Sonu Sahni2, Magdy Selim1, Vasileios-Arsenios Lioutas1
1Department of Neurology, Beth Israel Deaconess Medical Center, 2Pulmonary and Critical Care, Harlem Hospital Center - Columbia University
Objective:

With this study we aimed to assess the association of respiratory and metabolic acidosis in ICH with functional outcome and mortality.  

Background:
Systemic Acidosis is common in critical care settings and patients with intracerebral hemorrhage (ICH) frequently require intubation and ICU admission. The association between ICH and systemic acidosis has not been investigated.
Design/Methods:

Retrospective single center cohort of patients with acute spontaneous ICH. We examined 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). 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. We further stratified our analysis by ICU vs general ward admission and intubation status.

Results:

There was a total of 406 patients, average age 80.5 (±1.5) years, 174 (43%) females and 232 (57%) males. 134 (33%) patients were acidotic on admission, 42 (10%) had respiratory acidosis and the remaining 92 (23%) had metabolic acidosis. There was no statistically significant association between metabolic acidosis with either hospital mortality (p=0.21, 95% CI [0.37-1.24]) or 90-day favorable functional outcome (p=0.61, 95% CI [0.37-1.24]) after adjustment for hematoma volume and expansion, Glasgow Coma Scale, and presence of interventricular hemorrhage. There was no association between respiratory acidosis with either hospital mortality (p=1.00) or functional outcome (p=1.00) before the adjustment for confounders. There was no effect modification after stratifying by ICU and intubation status.

Conclusions:

In this retrospective cohort study, we found that systemic acidosis was present in one third of patients with spontaneous ICH. Unlike other critical neurological conditions such as traumatic brain injury, there was no significant association between metabolic and respiratory acidosis with mortality and 90-day functional outcome in ICH.

10.1212/WNL.0000000000203559