Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Acidosis-dependent inverse association between partial pressure of arterial carbon dioxide and mortality in acute ischemic stroke.
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Cheng Zicheng, Ma Lili, Zhao Meiqi, Xu Tong, Wang Jianing, Zhu Xinxia, Zhan Zhenxiang, Han Zhao
Аннотация
BACKGROUND: Acute ischemic stroke (AIS) is a major global health concern with significant economic consequences. While various neuroprotective treatments have been explored, a promising but under-investigated approach involves manipulating partial pressure of arterial carbon dioxide (PaCO2) levels. Experimental studies suggest that CO2 may exert neuroprotective effects through mechanisms such as anti-inflammatory and antioxidant roles. However, the clinical relationship between PaCO2 and mortality in AIS, particularly in relation to acidosis, remains unclear.
METHODS: This retrospective cohort study utilized the Medical Information Mart for Intensive Care-IV database to analyze data from adult patients diagnosed with AIS between 2008 and 2019. Patients were grouped based on the first 24-h PaCO2 quartiles, and 30-day mortality was the primary outcome. Secondary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay. Multivariable Cox regression models, restricted cubic spline (RCS) analyses, and subgroup analyses based on arterial blood potential of hydrogen (pH) were used to assess the associations between PaCO2 levels and clinical outcomes.
RESULTS: PaCO2 levels were lower in patients who died within 30 days or during hospitalization compared to survivors. In multivariable analysis, patients in the highest PaCO2 quartile (Q4: > 43.0 mmHg) had a 39 % reduced risk of 30-day mortality (hazard ratio [HR]: 0.61, 95 % confidence interval [CI]: 0.39-0.95) and a marginally reduced risk of in-hospital mortality (HR: 0.63, 95 % CI: 0.39-1.01). A non-significant association was found between PaCO2 and ICU length of stay. In subgroup analyses, the association was significant only in patients with acidosis (pH < 7.35), where PaCO2 > 43.0 mmHg reduced 30-day mortality by 70 % (HR: 0.30, 95 % CI: 0.12-0.75).
CONCLUSIONS: Increased PaCO2 levels were associated with lower 30-day mortality in patients with AIS, particularly in those with acidosis. These findings provide preliminary evidence supporting further investigation of CO2 inhalation as a potential therapeutic strategy for AIS in randomized controlled trials.
METHODS: This retrospective cohort study utilized the Medical Information Mart for Intensive Care-IV database to analyze data from adult patients diagnosed with AIS between 2008 and 2019. Patients were grouped based on the first 24-h PaCO2 quartiles, and 30-day mortality was the primary outcome. Secondary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay. Multivariable Cox regression models, restricted cubic spline (RCS) analyses, and subgroup analyses based on arterial blood potential of hydrogen (pH) were used to assess the associations between PaCO2 levels and clinical outcomes.
RESULTS: PaCO2 levels were lower in patients who died within 30 days or during hospitalization compared to survivors. In multivariable analysis, patients in the highest PaCO2 quartile (Q4: > 43.0 mmHg) had a 39 % reduced risk of 30-day mortality (hazard ratio [HR]: 0.61, 95 % confidence interval [CI]: 0.39-0.95) and a marginally reduced risk of in-hospital mortality (HR: 0.63, 95 % CI: 0.39-1.01). A non-significant association was found between PaCO2 and ICU length of stay. In subgroup analyses, the association was significant only in patients with acidosis (pH < 7.35), where PaCO2 > 43.0 mmHg reduced 30-day mortality by 70 % (HR: 0.30, 95 % CI: 0.12-0.75).
CONCLUSIONS: Increased PaCO2 levels were associated with lower 30-day mortality in patients with AIS, particularly in those with acidosis. These findings provide preliminary evidence supporting further investigation of CO2 inhalation as a potential therapeutic strategy for AIS in randomized controlled trials.