Evaluation of sex differences in acid/base and electrolyte concentrations in acute large vessel stroke

Sarah R Martha; Lisa A Collier; Stephanie M Davis; Akin Erol; Doug Lukins; Keith R Pennypacker; Justin F Fraser

doi:10.1016/j.expneurol.2019.113078

Evaluation of sex differences in acid/base and electrolyte concentrations in acute large vessel stroke

Exp Neurol. 2020 Jan:323:113078. doi: 10.1016/j.expneurol.2019.113078. Epub 2019 Nov 5.

Authors

Sarah R Martha¹, Lisa A Collier², Stephanie M Davis², Akin Erol³, Doug Lukins⁴, Keith R Pennypacker⁵, Justin F Fraser⁶

Affiliations

¹ College of Nursing, University of Kentucky, Lexington, KY, USA.
² Department of Neurology, University of Kentucky, Lexington, KY, USA.
³ College of Medicine, University of Kentucky, Lexington, KY, USA.
⁴ College of Medicine, University of Kentucky, Lexington, KY, USA; Departments of Neurosurgery, University of Kentucky, Lexington, KY, USA; Neuroscience, University of Kentucky, Lexington, KY, USA.
⁵ Department of Neurology, University of Kentucky, Lexington, KY, USA; Neuroscience, University of Kentucky, Lexington, KY, USA.
⁶ Department of Neurology, University of Kentucky, Lexington, KY, USA; College of Medicine, University of Kentucky, Lexington, KY, USA; Departments of Neurosurgery, University of Kentucky, Lexington, KY, USA; Neuroscience, University of Kentucky, Lexington, KY, USA; Radiology, University of Kentucky, Lexington, KY, USA. Electronic address: jfr235@uky.edu.

PMID: 31697942
DOI: 10.1016/j.expneurol.2019.113078

Abstract

Introduction: Ischemic stroke is the one of the most severe and debilitating diseases, and despite animal models, there is much to learn about the neuropathology in humans in a way that could inform the development of therapies. We have developed a protocol to collect and evaluate arterial blood immediately distal and proximal from the removed intracranial thrombus during mechanical thrombectomy. These samples provide a unique resource in evaluating acute changes in acid/base and electrolyte concentrations at the time of ischemic stroke. The purpose of this study was to compare acid/base and electrolytes obtained proximal and distal to the occluded intracranial thrombi between male and female acute ischemic stroke subjects at the time of thrombectomy; and to determine whether arterial blood gas values predict outcomes in male and female subjects.

Methods: We analyzed the first 49 subjects (age = 67 ± 15.0, 21 males) in the BACTRAC registry. We compared arterial blood gas of blood distal versus proximal to the thrombus during thrombectomy which provided acid/base levels (pH, pCO₂, pO₂, BD, HCO₃^-) and electrolyte values (iCa²⁺, K⁺, and Na⁺). Comparisons were evaluated by one-way repeated measures ANOVA (p < .05). Moderated multiple regression with an interaction term of sex determined predictors of infarct volume, edema volume, and infarct time.

Results: In general, distal intracranial luminal blood sample showed a compensated metabolic acidosis with an elevated oxygen concentration in both blood samples. Analysis indicated several significant differences in the proximal blood samples between sexes (pH, pCO₂, and K⁺). Bicarbonate and base deficit were predictors of infarct time specifically in female subjects.

Discussion and conclusion: Acid/base and electrolyte response to ischemic conditions differ between men and women, and these early changes could be used to predict local acid/base changes and how they develop differently in men and women during ischemia. These findings provide a novel insight into the pathology of large vessel stroke in humans, particularly potential variations based on sex.

Keywords: Acid/base; Electrolytes; Ischemic stroke; Sex differences.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Acidosis / blood*
Acids / blood
Aged
Blood Gas Analysis*
Electrolytes / blood*
Female
Humans
Hydrogen-Ion Concentration
Male
Middle Aged
Sex Characteristics*
Stroke / blood*
Stroke / surgery
Thrombectomy

Substances

Acids
Electrolytes