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Zhang Y, Wu F, Sun J, Xu C, Yang Q, Wang G. Serum albumin corrected anion gap levels are associated with poor prognosis in patients with acute ischemic stroke. Sci Rep 2025; 15:15579. [PMID: 40320448 PMCID: PMC12050287 DOI: 10.1038/s41598-025-00380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 04/28/2025] [Indexed: 05/08/2025] Open
Abstract
Acute ischemic stroke (AIS) remains a major cause of global morbidity and mortality. This study aimed to evaluate the role of albumin corrected anion gap (ACAG) as a prognostic marker for AIS patients. We analyzed data from 1014 AIS patients in the MIMIC-IV database, stratifying patients by ACAG levels. Using Cox proportional hazards models, restricted cubic splines, and Kaplan-Meier survival analysis, we assessed the relationship between ACAG and both 30-day and 365-day mortality. Our results show that elevated ACAG levels are significantly associated with higher mortality rates at both time points. The hazard ratios for 30-day and 365-day mortality were 1.07 (95% CI 1.04-1.11, P < 0.001) and 1.06 (95% CI 1.03-1.09, P < 0.001), respectively. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of ACAG for predicting 30-day and 365-day mortality was 0.666 and 0.662, respectively. Subgroup analysis revealed significant interactions with gender and sepsis status. A nomogram incorporating ACAG and other key variables achieved AUCs of 0.748 and 0.765 for predicting 30-day and 365-day mortality, respectively. These findings indicate that elevated ACAG is an independent risk factor for both short-term and long-term mortality in AIS patients. Its incorporation into clinical practice may enhance the ability of clinicians to identify high-risk patients early, enabling timely and targeted interventions.
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Affiliation(s)
- Yaxin Zhang
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Fan Wu
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Jiawei Sun
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Chuchuan Xu
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Qingwei Yang
- Department of Neurology, Xiamen University Affiliated Zhongshan Hospital, NO.201-209 HuBin south Road, Xiamen, 361004, Fujian, China.
| | - Guangdong Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, NO.277 YanTa West Road, Xi'an, 710061, Shanxi, China.
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Ruan AF, Zheng JW, Sun SQ, Liu XZ, Chen TL. The association of albumin-corrected anion gap and acute kidney injury in heart failure patients: a competing risk model analysis. BMC Cardiovasc Disord 2025; 25:277. [PMID: 40217175 PMCID: PMC11987305 DOI: 10.1186/s12872-025-04723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 04/01/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND The combination of heart failure (HF) and acute kidney injury (AKI) increases the mortality of patients. It is critical to identify HF patients who may have a high risk for AKI. Albumin-corrected anion gap (ACAG) is a new indicator, but there are no studies on ACAG and the risk of AKI in HF patients. METHODS Data for HF patients was obtained from the MIMIC-IV database. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were employed to evaluate the clinical value of ACAG in predicting AKI risk. Logistic regression analysis and restricted cubic spline (RCS) curve were conducted to explore the relationship between ACAG and AKI. A competing risk model was developed to further investigate the relationship between ACAG on AKI. RESULTS The study analyzed 5,972 HF patients, with 49.82% (2886/5972) suffering from AKI. The prediction performance of ACAG on AKI was good (AUC:0.656). Continuous ACAG was associated with AKI after adjusting for various significant variables (Model 1: OR = 1.094, 95%CI: 1.078-1.110; Model 2: OR = 1.150, 95%CI: 1.133-1.166; Model 3: OR = 1.035, 95%CI. 1.017-1.054). All High ACAG groups showed a higher risk of AKI (all P < 0.001). ACAG was also linked to in-hospital mortality (P < 0.001). The competing risks model revealed that high ACAG was still a risk factor for AKI when in-hospital mortality served as a competing risk event (P < 0.001). CONCLUSION High ACAG was associated with the risk of AKI in HF patients. Clinicians can risk-stratify HF patients by combining ACAG levels.
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Affiliation(s)
- Ai-Fang Ruan
- Department of cardiovascular medicine, Hangzhou Lin'an District Hospital of Traditional Chinese Medicine, Hangzhou, 311300, Zhejiang, China
| | - Jian-Wu Zheng
- Department of cardiovascular medicine, Hangzhou Hospital of Traditional Chinese Medicine, No.453 Stadium Road, Xihu District, Hangzhou, 310007, Zhejiang, China
| | - Shao-Qing Sun
- Department of cardiovascular medicine, Hangzhou Lin'an District Hospital of Traditional Chinese Medicine, Hangzhou, 311300, Zhejiang, China
| | - Xu-Zhu Liu
- Department of cardiovascular medicine, Hangzhou Lin'an District Hospital of Traditional Chinese Medicine, Hangzhou, 311300, Zhejiang, China
| | - Tie-Long Chen
- Department of cardiovascular medicine, Hangzhou Hospital of Traditional Chinese Medicine, No.453 Stadium Road, Xihu District, Hangzhou, 310007, Zhejiang, China.
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Bai N, Ying T, Li D, Liu A. Relationship between albumin-corrected anion gap and non-alcoholic fatty liver disease: a cross-sectional analysis of NHANES 2017-2018. Front Med (Lausanne) 2025; 12:1518540. [PMID: 40144875 PMCID: PMC11938069 DOI: 10.3389/fmed.2025.1518540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/25/2025] [Indexed: 03/28/2025] Open
Abstract
Objectives The objective of this study was to examine the correlation between the albumin-corrected anion gap (ACAG) and non-alcoholic fatty liver disease (NAFLD) using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Methods A cross-sectional analysis was conducted, comprising 4,379 participants, who were stratified into two groups: those with NAFLD and those without NAFLD. The baseline characteristics were compared using the most appropriate statistical tests. The relationship between ACAG levels and NAFLD was assessed using generalized linear models, with adjustments made for potential confounding factors. The analysis of threshold effects was conducted using piecewise regression. Furthermore, the relationship between ACAG and NAFLD was investigated in different age groups. Results The mean age of participants with non-alcoholic fatty liver disease (NAFLD) was significantly higher than that of non-NAFLD participants (48.88 vs. 43.46 years, p < 0.001). The presence of NAFLD was associated with higher levels of ACAG (18.80 ± 0.24 vs. 18.10 ± 0.19, p < 0.001). In fully adjusted models, each 1-unit increase in ACAG was associated with a significantly increased risk of NAFLD in participants under 60 years old (β: 0.87, 95% CI: 0.05, 1.69, p < 0.05). In younger participants, elevated NAFLD risk was observed in those with higher ACAG quartiles (P for trend <0.05). In contrast, no significant associations were identified in participants aged 60 years and older (P for trend >0.05), suggesting the presence of age-specific differences in the relationship between ACAG and NAFLD. Conclusion The impact of ACAG on NAFLD is significantly correlated, especially in the age group, where elevated levels of ACAG are associated with increased risk of NAFLD in young people. ACAG may be a potential and reliable biomarker for predicting NAFLD risk in clinical assessment, but its implementation should consider the patient's age factor.
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Affiliation(s)
- Ning Bai
- Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Ting Ying
- Research Institute of Digital and Intelligent Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Dejian Li
- Research Institute of Digital and Intelligent Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Aiguo Liu
- Research Institute of Digital and Intelligent Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Department of Orthopedics, The First Affiliated Hospital of Henan University, Kaifeng, China
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Liu A, Ying T, Deng S, Wang C, Zhao Z, Zhang S, Xiao H, Yi C, Li D. Relationship between albumin-corrected anion gap and lumbar spine bone mineral density: a cross-sectional study. FRONTIERS IN AGING 2025; 6:1511294. [PMID: 40007853 PMCID: PMC11850363 DOI: 10.3389/fragi.2025.1511294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 01/24/2025] [Indexed: 02/27/2025]
Abstract
Objectives This study aimed to investigate the relationship between albumin-corrected anion gap (ACAG) and lumbar spine bone mineral density (BMD) in a diverse population, assessing how variations in ACAG levels correlate with changes in lumbar spine BMD and the potential implications for osteoporosis risk. Methods A cross-sectional analysis was conducted involving 3,057 participants (1,555 males and 1,502 females). Participants were stratified into quartiles based on baseline ACAG levels. Demographic and clinical characteristics were analyzed, including age, sex, education level, body mass index (BMI), and prevalence of diabetes and hypertension. The association between ACAG and lumbar spine BMD was evaluated using multiple regression models, and a generalized additive model was employed to identify potential nonlinear relationships. Results The analysis revealed a significant negative correlation between ACAG and lumbar spine BMD (P < 0.001). For each 1-unit increase in ACAG, BMD decreased with β coefficients of -0.004 to -0.005 across various models. Quartile analysis indicated that participants in the highest ACAG quartile (≥19.55) experienced the most substantial reductions in BMD (β coefficients ranging from -0.034 to -0.036, P < 0.001). Furthermore, a U-shaped relationship was identified, with a turning point at an ACAG value of 22.15, indicating that lower ACAG levels were associated with decreased BMD, while higher levels showed a positive effect. Subgroup analyses by sex demonstrated consistent findings, with significant associations in both males and females. Conclusion The findings underscore a significant association between elevated ACAG levels and reduced lumbar spine BMD, suggesting that ACAG may serve as a valuable biomarker for assessing osteoporosis risk. The identified nonlinear relationship further emphasizes the complexity of metabolic influences on bone health. These results warrant further investigation into the mechanisms underlying ACAG's impact on bone density and its potential role in osteoporosis prevention strategies.
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Affiliation(s)
- Aiguo Liu
- Department of Orthopedics, The First Affiliated Hospital of Henan University, Kaifeng, China
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Ting Ying
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Shuang Deng
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Chenxu Wang
- Department of Orthopedics, The First Affiliated Hospital of Henan University, Kaifeng, China
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Ziwen Zhao
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Sitong Zhang
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Han Xiao
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Chengqing Yi
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Dejian Li
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Xu J, Wang Z, Wang Y, Chen X, Ma L, Wang X. Association of elevated albumin-corrected anion gap with all-cause mortality risk in atrial fibrillation: a retrospective study. BMC Cardiovasc Disord 2025; 25:55. [PMID: 39871159 PMCID: PMC11771038 DOI: 10.1186/s12872-025-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/23/2025] [Indexed: 01/29/2025] Open
Abstract
BACKGROUND Compared to the conventional anion gap, the albumin-corrected anion gap (ACAG) offers a more precise measure of acid-base imbalance, providing superior prognostic insight. However, the prognostic relevance of ACAG in individuals of atrial fibrillation (AF) remains insufficiently explored. This research seeks to evaluate the correlation between ACAG levels and mortality risk in individuals with AF. METHODS We identified individuals diagnosed with AF from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Participants were categorized into quartiles based on their ACAG levels. The outcomes included 30 days and 365 days all-cause mortality. Kaplan-Meier survival curves were utilized to evaluate cumulative survival across the ACAG quartiles. We applied Cox regression and restricted cubic spline regression analyses to evaluate the correlation between ACAG levels and prognosis. Subgroup analyses and interaction assessments were applied to confirm the robustness of the findings. RESULTS A total of 2920 AF patients (54.93% male) were incorporated into the analysis, with 1.61% identified as having paroxysmal AF. The 30-day and 365-day mortality rates were 22.91% and 39.21%, respectively. Kaplan-Meier survival curves demonstrated that elevated ACAG levels were significantly linked to increased mortality (log-rank P < 0.001). In multivariate Cox proportional hazards analyses, increased ACAG independently predicted mortality at both 30 days (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.02-1.05; P < 0.01) and 365 days (aHR, 1.03; 95% CI, 1.02-1.05; P < 0.01) after adjusting for potential confounders. A positive relationship between rising ACAG levels and mortality risk was showed by restricted cubic spline analysis. Subgroup analyses revealed no significant interactions (all interaction P-values > 0.05). CONCLUSIONS In individuals with AF, higher ACAG levels are related to a greater mortality risk at 30 and 365 days. These findings suggest that ACAG may serve as a valuable prognostic marker for AF patient stratification. Incorporating ACAG into clinical decision-making could support improved therapeutic strategies and enhance patient outcomes.
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Affiliation(s)
- Jia Xu
- Department of Electrocardiography Diagnosis, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Anhui, 230601, China
| | - Zhen Wang
- Department of Cardiovascular Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui, China
| | - Yun Wang
- Department of Electrocardiography Diagnosis, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Anhui, 230601, China
| | - Xinran Chen
- Department of Electrocardiography Diagnosis, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Anhui, 230601, China
| | - Lan Ma
- Department of Electrocardiography Diagnosis, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Anhui, 230601, China
| | - Xiaochen Wang
- Department of Cardiovascular Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui, China.
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Wang J, Yang P, Zeng X, Chen S, Chen X, Deng L, Shi R, Qin C, Luo H, Gong J, Luo H, Wang D. Prognostic significance of albumin corrected anion gap in patients with acute pancreatitis: a novel perspective. Sci Rep 2025; 15:1318. [PMID: 39779808 PMCID: PMC11711654 DOI: 10.1038/s41598-025-85773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 01/06/2025] [Indexed: 01/11/2025] Open
Abstract
This study aims to explore the relationship between the albumin-corrected anion gap (ACAG) and short- and long-term all-cause mortality (ACM) in patients with acute pancreatitis (AP) managed in the intensive care unit (ICU). We conducted a retrospective analysis utilizing data extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. This study sought to investigate the correlation between ACAG and ACM among patients diagnosed with AP across various disease stages. R statistical software was used to identify the optimal thresholds for ACAG. Kaplan-Meier survival curves and multivariate Cox proportional hazards regression models were employed to assess the association between ACAG and short- and long-term ACM of AP. The predictive ability, sensitivity, specificity, and area under the curve (AUC) of ACAG for short- and long-term ACM in AP were investigated using receiver operating characteristic analysis. Subgroup analyses were also conducted. A cohort comprising 605 participants was included in this study. The ideal threshold for ACAG identified by R statistical software was 21.5. Cox proportional hazards modeling revealed that there was an independent association between patients with AP with ACAG ≥ 21.5 and ACM at 3, 7, 10, 14, 28, 90, and 180 days and 1 year before and after adjustment for confounders. Survival curves demonstrated that patients with ACAG ≥ 21.5 had lower survival rates at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. In addition, ACAG showed superior performance, with a larger AUC than the anion gap, albumin, and Systemic Inflammatory Response Syndrome score and Sequential Organ Failure Assessment at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. Subgroup analysis revealed no significant interaction between ACAG and any subgroups Elevated levels of ACAG were found to be associated with increased short- and long-term ACM in patients with AP, and ACAG may be an independent predictor of ACM at different disease stages.
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Affiliation(s)
- Jianjun Wang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Sirui Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xi Chen
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Lan Deng
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Ruizi Shi
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Chuan Qin
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Huiwen Luo
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Hua Luo
- Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Decai Wang
- NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
- Department of Urology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
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Wang Y, Zhong L, Min J, Lu J, Zhang J, Su J. Albumin corrected anion gap and clinical outcomes in elderly patients with acute kidney injury caused or accompanied by sepsis: a MIMIC-IV retrospective study. Eur J Med Res 2025; 30:11. [PMID: 39773636 PMCID: PMC11705960 DOI: 10.1186/s40001-024-02238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Elderly acute kidney injury (AKI) occurring in the intensive care unit (ICU), particularly when caused or accompanied by sepsis, is linked to extended hospital stays, increased mortality rates, heightened prevalence of chronic diseases, and diminished quality of life. This study primarily utilizes a comprehensive critical care database to examine the correlation of albumin corrected anion gap (ACAG) levels with short-term prognosis in elderly patients with AKI caused or accompanied by sepsis, thus assisting physicians in early identification of high-risk patients. METHODS This study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v2.0) database. The patient population was divided into death and survival groups based on a 14-day prognosis. Subsequently, the entire population was further categorized into a normal ACAG group (12-20 mmol/L) and a high ACAG group (> 20 mmol/L) based on ACAG levels. The LASSO regression cross-validation method was employed to identify significant risk factors for inclusion in multivariate Cox regression analyses. A restricted cubic spline (RCS) was then employed to visually represent the correlation between ACAG levels and the risk of mortality in patients. Kaplan-Meier curves were utilized to plot the cumulative survival rates at 14 and 30 days for both patient groups. The robustness of the findings was subsequently evaluated through subgroup analyses. RESULTS Our study identified a total of 3741 eligible subjects, revealing higher all-cause mortality rates at both 14-day and 30-day intervals in the high ACAG group compared to the normal ACAG group (χ2 = 87.023, P < 0.001; χ2 = 90.508, P < 0.001). Cox regression analysis further demonstrated that an elevated ACAG on ICU admission independently posed a risk factor for both 14- and 30-day prognosis within this population. In addition, the analysis conducted using RCS revealed a non-linear association between the levels of ACAG and the risk of mortality at both 14 and 30 days in the patient cohort (χ2 = 18.220, P < 0.001; χ2 = 18.360, P < 0.001). The application of Kaplan-Meier analysis demonstrated a statistically significant decrease in cumulative survival rates among individuals with high ACAG levels (P < 0.001). Subgroup analyses indicated that ACAG levels interacted with cerebrovascular disease and acute pancreatitis on 14-day mortality (P < 0.05 for interaction). CONCLUSION Elevated ACAG levels at ICU admission are an independent risk factor for poor short-term prognosis, correlating with increased all-cause mortality at 14 and 30 days in elderly patients with AKI caused or accompanied by sepsis. This highlights the importance of monitoring ACAG in critically ill patients to identify those at higher risk of adverse outcomes early.
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Affiliation(s)
- Yongbin Wang
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, People's Republic of China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, People's Republic of China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China
| | - Jie Min
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, People's Republic of China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China
| | - Jianhong Lu
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, People's Republic of China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China
| | - Jinyu Zhang
- Department of Gastrointestinal Surgery, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, People's Republic of China
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China
| | - Jiajun Su
- Department of Emergency, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, People's Republic of China.
- Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, 313000, People's Republic of China.
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Jiang H, Lan X, Zhou L, Xie X. Association between albumin-corrected anion gap and kidney function in individuals with hypertension - NHANES 2009-2016 cycle. Ren Fail 2024; 46:2416719. [PMID: 39466713 PMCID: PMC11520097 DOI: 10.1080/0886022x.2024.2416719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/09/2024] [Accepted: 10/09/2024] [Indexed: 10/30/2024] Open
Abstract
OBJECTIVES Long-term uncontrolled hypertension increases the risk of kidney decompensation. This study aimed to explore the connection between albumin-corrected anion gap (ACAG) and kidney function in hypertensive patients. METHODS This study utilized data from 1988 participants diagnosed with hypertension sourced from the NHANES database. Binary logistic regression analysis and subgroup analysis were utilized to investigate the relationship between ACAG and kidney function. The study employed restricted cubic spline (RCS) to assess the non-linear associations between ACAG and eGFR, as well as ACAG and ACR. Furthermore, mediation and moderation effect analyses were carried out, with blood pressure serving as the mediator and moderator, ACAG as the independent variable, and eGFR and ACR as the dependent variables. Finally, the study developed ACAG-based models for predicting kidney function decline. RESULTS Higher ACAG is identified as an independent risk factor for eGFR < 60 mL/minute/1.73 m2 and ACR ≥ 30 mg/g. Results from RCS indicate a non-linear relationship between ACAG and eGFR, as well as between ACAG and ACR. The mediation effect analysis revealed that DBP mediated the relationship between ACAG and eGFR. Analysis on moderation effect demonstrated that SBP played a significant role in moderating the interaction between ACAG and ACR. Moreover, the models based on ACAG showed strong performance. CONCLUSIONS The levels of ACAG are found to be independently associated with both eGFR and ACR. Additionally, ACAG shows promise as a new and dependable biomarker for predicting the decline in kidney function in hypertensive patients.
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Affiliation(s)
- Hui Jiang
- Department of Ultrasound, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaofeng Lan
- Department of Ultrasound, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Linmeng Zhou
- Department of Ultrasound, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiang Xie
- Department of Ultrasound, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
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Zhou Q, Miao Y, Wang P, Li F, Li J, Li N. Association between albumin corrected anion gap and mortality in septic older adults. Geriatr Nurs 2024; 60:580-585. [PMID: 39461109 DOI: 10.1016/j.gerinurse.2024.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 09/28/2024] [Accepted: 10/07/2024] [Indexed: 10/29/2024]
Abstract
OBJECTIVES This study aimed to investigate the association between albumin corrected anion gap (ACAG) and 30-day mortality in septic older adults. METHODS In this study, multivariate Cox regression models and Kaplan-Meier analysis were employed to evaluate the correlation between ACAG and 30-day mortality in septic older adults. RESULTS After adjustment for potential confounders, each 1 mmol/L increase in ACAG was associated with a 6% increase in 30-day mortality (HR, 1.06 [1.03-1.08], P < 0.001). Higher levels of ACAG in septic older adults were associated with lower 30-day survival rates based on Kaplan-Meier analysis. CONCLUSIONS This study observed a significant correlation between higher ACAG and 30-day mortality in septic older adults, thus indicating the need for increased attention from clinicians for patients with higher ACAG levels.
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Affiliation(s)
- Qiang Zhou
- Department of Orthopedic Surgery, Hekou District People's Hospital, Dongying City, Shandong Province, China
| | - Yuxiu Miao
- Department of Operating Theatre, Dongying People's Hospital (Dongying Hospital of Shandong Provincial Hospital Group), Shandong Province, China
| | - Pengfei Wang
- Department of Traditional Chinese Medicine Hemorrhoids, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Fenghua Li
- Department of Radiology, Hekou District Traditional Chinese Medicine Hospital, Shandong Province, China
| | - Jianing Li
- Department of Cardiology, Dongying People's Hospital (Dongying Hospital of Shandong Provincial Hospital Group), Shandong Province, China
| | - Na Li
- Department of Anesthesiology, Hekou District People's Hospital, Dongying City, Shandong Province, China.
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Wang Y, Tao Y, Yuan M, Yu P, Zhang K, Ying H, Jiang R. Relationship between the albumin-corrected anion gap and short-term prognosis among patients with cardiogenic shock: a retrospective analysis of the MIMIC-IV and eICU databases. BMJ Open 2024; 14:e081597. [PMID: 39357986 PMCID: PMC11448225 DOI: 10.1136/bmjopen-2023-081597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 08/09/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVES We aimed to investigate the association between the albumin-corrected anion gap (ACAG) and the prognosis of cardiogenic shock (CS). DESIGN A multicentre retrospective cohort study. SETTING Data were collected from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) datasets. PARTICIPANTS 808 and 700 individuals from the MIMIC-IV and eICU-CRD, respectively, who were diagnosed with CS. PRIMARY AND SECONDARY OUTCOMES The primary endpoint was short-term all-cause mortality, including intensive care unit (ICU), in-hospital and 28-day mortality. The secondary endpoints were the 28-day free from the ICU duration and the length of ICU stay. RESULTS CS patients were divided into two groups according to the admission ACAG value: the normal ACAG group (≤20 mmol/L) and the high ACAG group (> 20 mmol/L). CS patients with higher ACAG values exhibited increased short-term all-cause mortality rates, including ICU mortality (MIMIC-IV cohort: adjusted HR: 1.43, 95% CI=1.05-1.93, p=0.022; eICU-CRD cohort: adjusted HR: 1.38, 95% CI=1.02-1.86, p=0.036), in-hospital mortality (MIMIC-IV cohort: adjusted HR: 1.31, 95% CI=1.01-1.71, p=0.03; eICU-CRD cohort: adjusted HR: 1.47, 95% CI=1.12-1.94, p=0.006) and 28-day mortality (adjusted HR: 1.42, 95% CI: 1.11 to 1.83, p=0.007). A positive linear correlation was observed between the ACAG value and short-term mortality rates via restricted cubic splines. Compared with the AG, the ACAG presented a larger area under the curve for short-term mortality prediction. In addition, the duration of intensive care was longer, whereas the 28-day free from the ICU duration was shorter in patients with a higher ACAG value in both cohorts. CONCLUSION The ACAG value was independently and strongly associated with the prognosis of patients with CS, indicating that the ACAG value is superior to the conventional AG value.
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Affiliation(s)
- Yuxing Wang
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yuhang Tao
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ming Yuan
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Pengcheng Yu
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Kai Zhang
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Hangying Ying
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ruhong Jiang
- Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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11
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Pan Z, Lin J, Huo C, Yin D, Guo Q. Increased serum albumin corrected anion gap levels are associated with poor prognosis in septic patients with liver cirrhosis. Sci Rep 2024; 14:21510. [PMID: 39277682 PMCID: PMC11401841 DOI: 10.1038/s41598-024-72703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024] Open
Abstract
The prognosis of septic patients with cirrhosis is worse compared to septic patients without cirrhosis. Early and accurate prognosis determination in patients with cirrhosis and sepsis is pivotal for guiding treatment decisions. The aim of this study was to investigate the association between albumin-corrected anion gap (ACAG) and clinical prognosis of patients with sepsis and cirrhosis. This study extracted data of patients with sepsis and cirrhosis from the Medical Information Mart for Intensive Care (MIMIC-IV) database. A total of 1340 patients (64.6% male) were enrolled. After confounders adjusting, elevated ACAG had a significant association with 28-day mortality (HR1.604; 95% CI 1.258-2.048; P < 0.001). Restricted cubic spline revealed that a linear relationship between ACAG and 28-day mortality (P-nonlinear = 0.089, P-overall = 0.001). According to the ROC curve analysis, the ACAG demonstrated a higher area under the curve (AUC) of 0.703 compared to AG (0.675). Kaplan-Meier analysis revealed higher 28-day mortality in high ACAG group (log-rank test, χ^2 = 175.638, P < 0.001). Furthermore, subgroup analysis showed a significant interaction between ACAG and etiology of cirrhosis (P for interaction = 0.014). Therefore, ACAG could provide clinicians with valuable insights for guiding interventions in this high-risk population.
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Affiliation(s)
- Zetao Pan
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
| | - Jiancheng Lin
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
| | - Cunyang Huo
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
| | - Di Yin
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
| | - Qiang Guo
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China.
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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12
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Lu Z, Yao Y, Xu Y, Zhang X, Wang J. Albumin corrected anion gap for predicting in-hospital death among patients with acute myocardial infarction: A retrospective cohort study. Clinics (Sao Paulo) 2024; 79:100455. [PMID: 39079461 PMCID: PMC11334651 DOI: 10.1016/j.clinsp.2024.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/11/2024] [Accepted: 07/11/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE To explore the relationship between Anion Gap (AG), Albumin Corrected AG (ACAG), and in-hospital mortality of Acute Myocardial Infarction (AMI) patients and develop a prediction model for predicting the mortality in AMI patients. METHODS This was a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC)-Ⅲ, MIMIC-IV, and eICU Collaborative Study Database (eICU). A total of 9767 AMI patients who were admitted to the intensive care unit were included. The authors employed univariate and multivariable cox proportional hazards analyses to investigate the association between AG, ACAG, and in-hospital mortality; p < 0.05 was considered statistically significant. A nomogram incorporating ACAG and clinical indicators was developed and validated for predicting mortality among AMI patients. RESULTS Both ACAG and AG exhibited a significant association with an elevated risk of in-hospital mortality in AMI patients. The C-index of ACAG (C-index = 0.606) was significantly higher than AG (C-index = 0.589). A nomogram (ACAG combined model) was developed to predict the in-hospital mortality for AMI patients. The nomogram demonstrated a good predictive performance by Area Under the Curve (AUC) of 0.763 in the training set, 0.744 and 0.681 in the external validation cohort. The C-index of the nomogram was 0.759 in the training set, 0.756 and 0.762 in the validation cohorts. Additionally, the C-index of the nomogram was obviously higher than the ACAG and age shock index in three databases. CONCLUSION ACAG was related to in-hospital mortality among AMI patients. The authors developed a nomogram incorporating ACAG and clinical indicators, demonstrating good performance for predicting in-hospital mortality of AMI patients.
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Affiliation(s)
- Zhouzhou Lu
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu Province, PR China
| | - Yiren Yao
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu Province, PR China
| | - Yangyang Xu
- The Second Clinical Medicine School, Nanjing Medical University, Nanjing, PR China
| | - Xin Zhang
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu Province, PR China
| | - Jing Wang
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu Province, PR China.
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13
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Lou Z, Zeng F, Huang W, Xiao L, Zou K, Zhou H. Association between the anion-gap and 28-day mortality in critically ill adult patients with sepsis: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e39029. [PMID: 39058855 PMCID: PMC11272324 DOI: 10.1097/md.0000000000039029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Metabolic acidosis is usually associated with the severity of the condition of patients with sepsis or septic shock. Serum anion gap (AG) is one of the indicators of response metabolism. This study was performed to investigate whether the initial serum AG is associated with the 28-day mortality in critically ill adult patients with sepsis. This retrospective cohort study, a total of 15,047 patients with confirmed Sepsis disease from 2008 to 2019 from the Medical Information Mart for Intensive Care IV (MIMIC-IV) v1.0 database. The MIMIC-IV database is a comprehensive, de-identified clinical dataset originating from the Beth Israel Deaconess Medical Center in Boston, it includes extensive data on intensive care unit (ICU) patients, such as vital signs, lab results, and medication orders, spanning multiple years, accessible to researchers through an application process. AG can be obtained by direct extraction in the MIMIC-IV database (itemid = 50,868 from the laboratory events table of mimic_hosp), inclusion of AG values for the first test on first day of ICU admission. The patients were grouped into quartiles according to the AG interquartile range. The primary outcome was the 28-day mortality. Multiple logistic regression analysis was used to calculate the odds ratio (OR), while accounting for potential confounders, and the robustness of the results were evaluated in subgroup analyses. Among the 15,047 patients included in this study, the average age was 65.9 ± 16.0 years, 42.5% were female, 66.1% were Caucasian, and the 28-day mortality rate was 17.9% (2686/15,047). Multiple logistic regression analysis revealed the 28-day mortality in every increase of AG (per SD mEq/L), there is an associated 1.2 times (OR 1.2, 95% CI 1.12-1.29, P < .001) increase. Increased 28-day mortality (OR 1.53, 95% confidence interval 1.29-1.81, P < .001) in the group with the AG (15-18 mEq/L), and (OR 1.69, 95% confidence interval 1.4-2.04, P < .001) in the group with the highest AG (≥18 mEq/L), AG (<12 mEq/L) as a reference group, in the fully adjusted model. In adult patients with sepsis, the early AG at the time of ICU admission is an independent risk factor for prognosis.
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Affiliation(s)
- Zeying Lou
- Internal Medicine, The Second Hospital of Xingguo County, Ganzhou City, Jiangxi Province, China
| | - Fanghua Zeng
- Department of Critical Care Medicine, The Second Hospital of Xingguo County, Ganzhou City, Jiangxi Province, China
| | - Wenbao Huang
- Department of Critical Care Medicine, The Second Hospital of Xingguo County, Ganzhou City, Jiangxi Province, China
| | - Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi Province, China
| | - Kang Zou
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi Province, China
| | - Huasheng Zhou
- Department of Critical Care Medicine, The Second Hospital of Xingguo County, Ganzhou City, Jiangxi Province, China
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14
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Gucyetmez B, Gucyetmez K, Sarikaya ZT, Telci L. Independent variables of pH: Ten Knights of the Hydrogen Ion Kingdom-Part I. A prospective observational study. PLoS One 2024; 19:e0306756. [PMID: 38985737 PMCID: PMC11236170 DOI: 10.1371/journal.pone.0306756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/22/2024] [Indexed: 07/12/2024] Open
Abstract
CO2, HCO3, SID, and total weak acids have been defined as pH's independent variables. However, according to Gamble, HCO3 should be equal to the difference between the sum of cations and the sum of anions besides HCO3. Therefore, if this mathematical expression is substituted for HCO3 in the Henderson-Hasselbalch equation, all independent variables of pH can be demonstrated. Our aim is to test this theory in this study. This prospective observational study was conducted between 2019 and 2020. All admitted patients to the intensive care unit who were >18 years old were included. Demographic data, blood gas parameters, albumin, magnesium, and inorganic phosphorus levels, and outcomes were recorded twice (at admission and at the 24th hour). The multivariate linear regression model was used to determine pH's independent variables. In the multivariate linear regression model, pH was significantly increased by each unit increase in Na, K, Ca, and Mg (mmol L-1). In contrast, pH was significantly decreased by each unit increase in CO2, Cl, lactate, albumin (g dL-1), inorganic phosphorus (mg dL-1), and the strong ion gap. Ten independent variables can accurately predict the changes in pH. For this reason, all ten independent variables should be separately evaluated when interpreting the acid-base status. With this understanding, all algorithms regarding acid-base evaluation may become unnecessary.
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Affiliation(s)
- Bulent Gucyetmez
- Department of Anesthesiology and Reanimation, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Kaan Gucyetmez
- Department of Computer Science, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Zeynep Tugce Sarikaya
- Department of Anesthesiology and Reanimation, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Lutfi Telci
- General Intensive Care Unit, Acibadem International Hospital, Istanbul, Turkey
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Sheng H, Lu J, Zhong L, Hu B, Sun X, Dong H. The correlation between albumin-corrected anion gap and prognosis in patients with acute myocardial infarction. ESC Heart Fail 2024; 11:826-836. [PMID: 38164072 DOI: 10.1002/ehf2.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Acute myocardial infarction (AMI) is a cardiovascular disease with high morbidity and mortality. We collected patients with AMI from the Medical Information Mart for Intensive Care IV (v2.0) database and explored the association between serum albumin-corrected anion gap (ACAG) level and mortality in patients with AMI. METHODS AND RESULTS Data of adult patients with AMI were collected. According to the 360 day prognosis, patients were divided into survival and non-survival groups. Based on the ACAG level, patients were then divided into normal and high ACAG groups. Cox hazard proportional models and restricted cubic splines (RCSs) were used to investigate the correlation between ACAG and mortality. Kaplan-Meier curves were created to compare the cumulative survival rates between the high and normal ACAG groups. The receiver operating characteristic (ROC) curve was used to analyse the predictive value of ACAG for the prognosis of patients with AMI. Sensitivity and subgroup analyses were conducted to revalidate the results. Finally, 1783 patients were included. Elevated ACAG (>20 mmol/L) was significantly associated with 30 and 360 day mortality (P < 0.001). Adjusted for multiple confounding factors, the Cox proportional hazard analysis showed that elevated ACAG (>20 mmol/L) was an independent risk factor of increased all-cause mortality in patients with AMI (hazard ratio 1.423, 95% confidence interval 1.206-1.678, P < 0.001). RCS analysis further showed that there was a non-linear trend relationship between ACAG and the risk of all-cause mortality at 30 and 360 days (χ2 = 10.750, P = 0.013; χ2 = 13.960, P = 0.003). Kaplan-Meier survival curves showed that the 30 and 360 day cumulative survival rates of patients with AMI were significantly lower (log-rank test, χ2 = 98.880, P < 0.001; χ2 = 105.440, P < 0.001) in the high ACAG group. ROC curve analysis showed that the area under the curve (AUC) of ACAG was 0.651, while the AUC of anion gap (AG) was 0.609, indicating that ACAG had a higher predictive value for 360 day mortality than AG. When combined with Sequential Organ Failure Assessment score, the predictive performance of ACAG for 360 day mortality was better, with an AUC of 0.699. Sensitivity and subgroup analyses were conducted suggesting the stability of our results. CONCLUSIONS Elevated serum ACAG (≥20 mmol/L) is an independent risk factor for short-term and long-term mortality in critically ill patients with AMI, and it may assist clinicians and nurses identifying high-risk patients.
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Affiliation(s)
- Haiying Sheng
- Department of Digital Subtraction Angiography, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Jianhong Lu
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Beiping Hu
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Xu Sun
- Department of General Surgery, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Huifeng Dong
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
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16
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Yin F, Qiao Z, Wu X, Shi Q, Jin R, Xu Y. Association between albumin-corrected anion gap and in-hospital mortality of intensive care patients with trauma: A retrospective study based on MIMIC-Ⅲ and Ⅳ databases. PLoS One 2024; 19:e0300012. [PMID: 38452113 PMCID: PMC10919588 DOI: 10.1371/journal.pone.0300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To investigate the correlation between albumin-corrected anion gap(ACAG) within the first 24 hours of admission and in-hospital mortality in trauma patients in intensive care unit(ICU). MATERIALS AND METHODS We utilized the MIMIC-Ⅲ and MIMIC-Ⅳ databases to examine trauma patients admitted to the ICU. The relationship between ACAG and in-hospital mortality in trauma patients was analyzed using Receiver Operating Characteristic(ROC) curve, Kaplan-Meier (K-M) survival curve, and Cox regression model. Propensity score matching (PSM) and subgroup analysis were conducted to enhance stability and reliability of the findings. Mortality at 30-day and 90-day served as secondary outcomes. RESULTS The study enrolled a total of 1038 patients. The AUC for ACAG (0.701, 95%CI: 0.652-0.749) was notably higher than that for anion gap and albumin. The Log-rank test revealed that the optimal cut-off point of ACAG for predicting in-hospital mortality was determined to be 20.375mmol/L. The multivariate Cox regression analysis demonstrated an independent association between high ACAG level and a higher risk of in-hospital mortality (HR = 3.128, 95% CI: 1.615-6.059). After PSM analysis, a matched cohort consisting of 291 subjects was obtained. We found no signifcant interaction in most stratas. Finally, The in-hospital, 30-day, and 90-day survival rates in the high ACAG group exhibited a statistically decrease compared to those in the low ACAG group both pre- and post-matching. CONCLUSION The elevated level of ACAG was found to be independently associated with increased in-hospital mortality among trauma patients in the ICU.
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Affiliation(s)
- Fei Yin
- Department of Emergency, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Xiaofei Wu
- Department of Emergency, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Qiang Shi
- Department of Emergency, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Rongfei Jin
- Department of Emergency, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Yuzhou Xu
- Department of Orthopedics, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
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Gucyetmez B, Sarikaya ZT, Tuzuner F. Elevated strong ion gap: A predictor of the initiation of continuous renal replacement therapy in acute kidney injury. Am J Med Sci 2024; 367:112-118. [PMID: 37980967 DOI: 10.1016/j.amjms.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/02/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND There is no optimal timing for continuous renal replacement therapy (CRRT) in acute kidney injury (AKI). AKI is a reason for the increased unmeasured anions, which refers to the increased organic acids in the blood, and they can be detected by calculating strong ion gap (SIG). SIG level at the moment of the AKI diagnosis may be a predictor for the initiation of CRRT. METHODS Patients who were diagnosed with AKI in the first week of the intensive care unit (ICU) period were included in this prospective observational study. At the moment of the AKI diagnosis, blood gas samples were recorded, and SIG was calculated. RESULTS The median level of SIG at the moment of the AKI diagnosis of CRRT (+) patients was significantly higher than CRRT (-) patients (7.4 and 3.2 mmol L-1, respectively). In the multivariate Cox regression analysis, the likelihood of the initiation of CRRT was increased 1.16-fold (1.01-1.33) and 4.0-fold (1.9-8.7) by only 1 mmol L-1 increases in SIG and SIG ≥6 mmol L-1 at the moment of AKI diagnosis, respectively (p = 0.035 and p < 0.001). CONCLUSIONS Increased SIG at the moment of the AKI diagnosis in patients with AKI may be a predictive marker to initiate CRRT.
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Affiliation(s)
- Bulent Gucyetmez
- Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.
| | - Zeynep Tugce Sarikaya
- Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Filiz Tuzuner
- General Intensive Care, Acıbadem Taksim Hospital, Istanbul, Turkey
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Yu W, Wen Y, Shao Y, Hu T, Wan X. Relationship between anion gap and in-hospital mortality in intensive care patients with liver failure: a retrospective propensity score matching analysis. Am J Transl Res 2024; 16:98-108. [PMID: 38322565 PMCID: PMC10839379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVES To elucidate the association between anion gap (AG) and in-hospital mortality in intensive care patients with liver failure. METHODS Demographic and clinical characteristics of intensive care patients with liver failure in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database were collected, and binomial logistic and Cox regression was conducted to investigate the association between AG and in-hospital mortality. The area under the receiver operating characteristic (ROC) curve (AUC) was conducted to characterize the performance of AG in predicting in-hospital mortality, and was compared with the albumin corrected anion gap (ACAG) and the End-Stage Liver Disease (MELD) score. The Kaplan-Meier curve was plotted for in-hospital survival analysis of AG and patients with liver failure. The propensity score matching (PSM) analysis was performed to mitigate selection bias. RESULTS AG was an independent risk factor for in-hospital mortality in intensive care patients with liver failure. Before PSM, the AUCs of AG, ACAG, and MELD were 0.666, 0.682, and 0.653, respectively. After PSM, the AUCs of AG, ACAG, and MELD scores were 0.645, 0.657, and 0.645, respectively, and there is no difference in the predictive performance of the three indicators upon comparison. Compared with the low-AG (≤20 mmol/L) group, the hazard ratio (HR) for in-hospital death of the high-AG (>20 mmol/L) group was determined to be 2.1472 (before PSM)/1.8890 (after PSM). CONCLUSIONS AG is associated with in-hospital mortality in intensive care patients with liver failure and demonstrates a moderate predictive value, which is comparable to the predictive power of the MELD score. AG may serve as an indirect marker of in-hospital mortality of patients with liver failure by reflecting the degree of metabolic acidosis.
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Affiliation(s)
- Wei Yu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yao Wen
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yu Shao
- Department of Gastroenterology, Chongqing Emergency Medical Center, Chongqing University Central HospitalChongqing, China
| | - Tianyang Hu
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Xiaoqiang Wan
- Department of Gastroenterology, Chongqing Emergency Medical Center, Chongqing University Central HospitalChongqing, China
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Gao P, Min J, Zhong L, Shao M. Association between albumin corrected anion gap and all-cause mortality in critically ill patients with acute kidney injury: a retrospective study based on MIMIC-IV database. Ren Fail 2023; 45:2282708. [PMID: 37975171 PMCID: PMC11001314 DOI: 10.1080/0886022x.2023.2282708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The early identification of patients at high risk for acute kidney injury (AKI) with a poor prognosis is crucial to prevent complications and minimize mortality. This study sought to investigate the association between albumin-corrected anion gap (ACAG) and all-cause mortality among critically ill patients with AKI. METHODS All eligible AKI patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV version 2.0) database were considered for participation in this study. We employed Kaplan-Meier curves to assess the 30-d and 360-d cumulative survival rates among various groups. Flexibly visualizing the connection between ACAG and mortality, we utilize restricted cubic splines (RCS) and multivariate Cox regression models. Result robustness underwent assessment through subgroup analyses and sensitivity analyses. Receiver-operating characteristic (ROC) curves were generated to evaluate the predictive performance of ACAG. RESULTS The study included 9625 AKI participants, of whom 58.60% were male, and the 360-d all-cause mortality rate was 39.89%. According to Kaplan-Meier analysis, the 30-d and 360-d cumulative survival rates for AKI patients were significantly lower in the high ACAG group than in the normal ACAG group. RCS analysis indicated that ACAG levels had a non-linear correlation with the risk of 30-d and 360-d mortality for AKI patients. Cox regression analysis demonstrated that ACAG is an independent risk indicator for 30-d and 360-d prognosis in AKI patients in the ICU. CONCLUSIONS Elevated ACAG levels (> 20 mmol/L) at ICU admission were associated with 30-d and 360-d all-cause mortality in critically ill patients with AKI.
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Affiliation(s)
- Penghui Gao
- Department of Emergency, The Second Hospital of Shandong University, Jinan, PR China
| | - Jie Min
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, PR China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, PR China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, PR China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, PR China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, PR China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, PR China
| | - Mingju Shao
- Department of Emergency, The Second Hospital of Shandong University, Jinan, PR China
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Gündoğan Uzunay B, Köker A, Ülgen Tekerek N, Dönmez L, Dursun O. Role of Albumin-corrected Anion Gap and Lactate Clearance in Predicting Mortality in Pediatric Intensive Care Patients. Balkan Med J 2023; 40:430-434. [PMID: 37815408 PMCID: PMC10613740 DOI: 10.4274/balkanmedj.galenos.2023.2023-7-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
Background Identifying mortality risk in critically ill children is central to diagnostic and treatment practices. For this purpose, scoring systems, such as the Pediatric Index of Mortality 3 (PIM 3), have been proposed; however, the role of biochemical markers, such as albumin-corrected anion gap (cAG) and lactate clearance (LC), in predicting mortality in pediatric intensive care unit (PICU) patients is yet to be explored. Aims To evaluate the predictive value of the cAG and LC for mortality in pediatric patients admitted to a PICU. Study Design Retrospective single-center cohort study. Methods Clinical and laboratory data from the time of PICU admission were collected, and patients were classified into based on their 0- and 6-hour of admission lactate levels into an LC(+) group (patients with normal or decreasing lactate levels) or an LC(−) group (increasing lactate levels). LC and cAG levels were compared using the Mann-Whitney U test and Student’s t-test, respectively. Additionally, multiple logistic regression analysis was performed to evaluate the effect of LC and cAG on mortality. Results We included 825 patients in the study; the mortality rate was 8.6%. The absence of LC [adjusted odds ratio (AOR) =4.735; 95% confidence interval (CI): 2.163-10.367; p < 0.001], cAG (AOR =1.064; 95% CI: 1.010-1.122; p = 0.019) and PIM 3 (AOR = 1.871; 95% CI: 1.553-2.254; p < 0.001) were independent risk factors for mortality. Using the receiver operating characteristic curve analysis of PIM 3 as a predictor of mortality, area under the curve values of 0.832 (95% CI: 0.805-0.857; p < 0.001) for the original score and 0.858 for a revised PIM 3 score (based on the β coefficients obtained for cAG and LC; 95% CI 0.832-0.881; p < 0.001) were obtained, which was significantly different (p = 0.027). Conclusion A cAG value > 18 at the time of PICU admission high lactate levels which do not decrease within 6 hours of hospitalization are associated with an increased risk of mortality. The revised PIM 3 score, which includes cAG and LC, is a better predictor of mortality than the classical PIM 3 score.
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Affiliation(s)
| | - Alper Köker
- Department of Pediatrics Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Nazan Ülgen Tekerek
- Department of Pediatrics Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Levent Dönmez
- Department of Public Health, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Oğuz Dursun
- Department of Pediatrics Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Türkiye
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Wang S, Teng H, Han H, Xu Y. The relationship between albumin corrected anion gap levels and mortality in patients with asthma in the ICU. Sci Rep 2023; 13:16903. [PMID: 37803051 PMCID: PMC10558512 DOI: 10.1038/s41598-023-44182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023] Open
Abstract
Although previous studies have suggested that albumin-corrected anion gap (ACAG) may be a predictor of mortality in critically ill patients in intensive care unit (ICU), its utility in the context of asthma has not been definitively established. In this study, baseline data, albumin concentration, anion gap (AG) and 30-d mortality data were retrieved from the Medical Information Mart for Intensive Care IV database (MIMIC-IV) for patients with asthma in the intensive care unit. Receiver operating characteristic (ROC) curves were constructed to analyze the predictive ability of ACAG and AG. The risk of 30-day mortality among patients with ACAG and asthma was analyzed using a restricted cubic spline (RCS) plot. Decision curve analysis (DCA) was used to evaluate the clinical usefulness of ACAG as a prognostic factor for 30-day mortality. Subsequently, subgroup analysis was conducted to explore potential variations in the relationship between ACAG and 30-day mortality based on factors such as sex, age, whether the asthma was acute, and other co-morbidities. Our study reveals that ACAG is a significant independent predictor of 30-day mortality in asthmatic patients receiving intensive care. The area under the AUC curve for ACAG was found to be 0.703, which is higher than that of AG, indicating that ACAG has a better predictive ability for 30-day mortality in this population. Furthermore, higher levels of ACAG were found to be associated with increased risk of 30-day mortality in asthmatic patients. In addition, decision curve analysis (DCA) demonstrated that the net benefit of ACAG was greater than that of AG. These findings suggest that ACAG may be a valuable prognostic factor for predicting 30-day mortality in asthmatic patients in the ICU. Our study provides evidence that ACAG is associated with an increased risk of 30-d mortality and has better predictive value in patients with combined asthma who are admitted to the ICU than AG.
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Affiliation(s)
- Shidong Wang
- Department of Respiratory Medicine, Shaoxing Second Hospital, Shaoxing, China.
| | - Hong Teng
- Department of Respiratory Medicine, Shaoxing Second Hospital, Shaoxing, China
| | - Hongyan Han
- Department of Respiratory Medicine, Shaoxing Second Hospital, Shaoxing, China
| | - Yunjie Xu
- Department of Respiratory Medicine, Shaoxing Second Hospital, Shaoxing, China
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Haber LA, Dhaliwal G, Lo L, Rizzuto G. Evaluating a low anion gap: A practical approach. Cleve Clin J Med 2023; 90:619-623. [PMID: 37783490 PMCID: PMC11924111 DOI: 10.3949/ccjm.90a.23035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
In teaching and in practice, little attention is given to a low anion gap. This oversight can result in a missed opportunity to diagnose acute or chronic disorders requiring treatment. In this article, we review the constituents of the anion gap, build a differential diagnosis for a low anion gap using case examples, and provide a stepwise approach to diagnostic testing to evaluate this abnormal finding.
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Affiliation(s)
- Lawrence A Haber
- Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, University of Colorado, Denver, CO
| | - Gurpreet Dhaliwal
- Medical Service, VA San Francisco Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Lowell Lo
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA
| | - Gabrielle Rizzuto
- Human Oncology and Pathogenesis Program, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Aydın SŞ, Aksakal E. Relationship Between Albumin-Corrected Anion Gap and Mortality in Hospitalized Heart Failure Patients. Cureus 2023; 15:e45967. [PMID: 37900402 PMCID: PMC10600590 DOI: 10.7759/cureus.45967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a disease with high morbidity and mortality. Despite the efforts to reduce mortality rates through medical progress, it is necessary to develop markers to identify critically ill patients. In our study, we aimed to investigate the relationship between albumin-corrected anion gap (ACAG) and mortality in hospitalized patients with HF. METHODOLOGY We performed a retrospective study that included patients with HF hospitalized in the Erzurum City Hospital between 2015 and 2022. The basal clinical, hematological, and biochemical findings of the patients were obtained from the electronic medical records. ACAG was calculated. The date and causes of death of the patients were searched and recorded through the Republic of Türkiye Ministry of Health Death Notification System (ÖBYS) and Central Population Administration System (MERNIS). Thus, the relationship between ACAG and mortality in hospitalized patients with HF was evaluated. RESULTS A total of 205 patients hospitalized for HF were included in the study. The mean age of all people in this study was 71.8 ± 10.7 years. A total of 104 (50.7%) of the patients included in the study were women. The mean left ventricular ejection fraction was 47.2 ± 13.6%. The mean follow-up period of the entire population was 76.5 ± 18.9 months. The mortality rate was 11.7% (24 patients). Serum anion gap (SAG) and ACAG were significantly higher in the group with death outcomes (p = 0.043 and p = 0.012, respectively). Cox regression analysis showed that ACAG was an independent predictor of HF mortality (p = 0.003). ACAG area under the curve was 0.773 (95% CI 0.634 - 0.914), the cut-off was 13, sensitivity was 75%, and specificity was 75.9% (p = 0.002). CONCLUSION Statistical analysis showed a meaningful connection between an increase in ACAG and mortality in hospitalized patients with HF. Consequently, ACAG can be used as an independent predictor of mortality in patients with HF.
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Jian L, Zhang Z, Zhou Q, Duan X, Xu H, Ge L. Association between albumin corrected anion gap and 30-day all-cause mortality of critically ill patients with acute myocardial infarction: a retrospective analysis based on the MIMIC-IV database. BMC Cardiovasc Disord 2023; 23:211. [PMID: 37118662 PMCID: PMC10148465 DOI: 10.1186/s12872-023-03200-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/22/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The anion gap (AG) has been linked to the prognosis of many cardiovascular disorders. However, the correlation between albumin-corrected anion gap (ACAG) and 30 d all-cause mortality of intensive care patients with acute myocardial infarction (AMI) is unclear. Furthermore, owing to the lack of studies, it is also unknown whether ACAG is more accurate than AG in predicting the mortality of AMI. METHODS The Medical Information Mart for Intensive Care IV (MIMIC IV) dataset was used to provide patient data in this retrospective cohort study. ACAG is computed using the formulae: [4.4-{albumin (g/dl)}] × 2.5 + AG. The primary outcome was 30 d all-cause mortality intensive care patients with AMI. To explore the prognostic worthiness of ACAG, the receiver operating characteristic curve, smooth curve fitting, Cox regression model, and Kaplan survival analysis was performed. RESULTS We enrolled 2,160 patients in this study. ACAG had a better predictive value for 30 d all-cause mortality than AG, with an area under the curve of 0.66. The association between ACAG levels and overall mortality was nonlinear. In our model, after correcting for confounding factors, the ACAG was the independent predictor for 30 d all-cause mortality (HR 1.75, 95%CI 1.24, 2.47). ACAG K-M estimator curve analyses revealed that the group with ACAG ≥ 21.75 mmol/l had poor survival rate than the other group. CONCLUSIONS High serum ACAG levels were a significant risk factor for 30 d all-cause mortality in critically ill patients with AMI. ACAG concentration and 30 d all-cause mortality had a nonlinear relationship. ACAG had better predictive value in identifying 30 d all-cause mortality of patients with AMI in ICU than the AG.
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Affiliation(s)
- Linhao Jian
- Department of the First Clinical College, Jinan University, 601 Huangpu Avenue West, Guangzhou, 510632, China
- Department of Cardiology, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China
| | - Zhixiang Zhang
- Department of Cardiology, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China
| | - Quan Zhou
- Department of Science and Education, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China
| | - Xiangjie Duan
- Department of Infectious Diseases, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China
| | - Haiqin Xu
- Department of Cardiac Electrophysiology, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China
| | - Liangqing Ge
- Department of Cardiology, The First People's Hospital of Changde, 818 Renmin Avenue, Changde City, 415003, China.
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Hu B, Zhong L, Yuan M, Min J, Ye L, Lu J, Ji X. Elevated albumin corrected anion gap is associated with poor in-hospital prognosis in patients with cardiac arrest: A retrospective study based on MIMIC-IV database. Front Cardiovasc Med 2023; 10:1099003. [PMID: 37034339 PMCID: PMC10076801 DOI: 10.3389/fcvm.2023.1099003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Cardiac arrest(CA) is one of the most leading causes of death. Most of the indicators which used to predict the prognosis of patients with CA are not recognized. Previous studies have suggested that albumin corrected anion gap (ACAG) is associated with recovery of spontaneous circulation in patients with CA, but the predictive value of ACAG for prognosis has not been investigated. This study aims to explore the relationship between ACAG and prognosis during hospitalization in patients with CA. Methods The baseline data of adult patients with CA hospitalized in the intensive care unit (ICU) from 2008 to 2019 in the American Intensive Care Database (MIMIC-IV, version v2.0) were collected. According to the in-hospital prognosis, patients were divided into survival and non-survival group. Based on the criteria of ACAG level in the previous literature, patients enrolled were divided into normal ACAG (12-20 mmol/L) and high ACAG (>20 mmol/L) group. The basic information of patients during hospitalization were compared and analyzed between the two groups with propensity score matching (PSM). The Kaplan-Meier method was used to compare the cumulative survival rates of normal ACAG and high ACAG groups before and after matching. Restricted cubic spline (RCS) method and multivariate COX proportional hazards regressions were used to analyze whether elevated ACAG was associated with all-cause mortality during hospitalization. Results A total of 764 patients were included. A matched cohort (n = 310) was obtained after PSM analysis. The mortality rate before and after matching in the high ACAG group was higher than that in the normal ACAG group (χ 2 = 25.798; P < 0.001; χ 2 = 6.258; P = 0.012) The Kaplan-Meier survival analysis before and after matching showed that the cumulative survival rate of the high ACAG group was lower (P < 0.05). RCS analysis showed that ACAG had a non-linear relationship with the risk of in-hospital all-cause mortality (χ 2 = 6.060, P < 0.001). Multivariate COX regression analysis before and after PSM suggested that elevated ACAG was an independent risk factor for all-cause mortality in patients with CA during hospitalization (P < 0.01). Conclusions Elevated ACAG is associated with increased all-cause mortality in patients with CA during hospitalization, it can be an independent risk factor for poor prognosis in patients with CA and remind clinicians to pay more attention to these patients.
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Abstract
Diabetic ketoacidosis (DKA) is a form of a hyperglycemic emergency mainly characterized by the triad of hyperglycemia, ketosis, and anion gap metabolic acidosis. DKA may be the initial presentation in approximately 25-40 % of patients with type 1 diabetes. It may also occur in at least 34% of patients with type 2 diabetes. DKA has economic as well as medical implications. This review aims to explore and discuss diabetic ketoacidosis, its pathophysiology, clinical presentation, diagnosis, and management, including nuances in special populations such as pediatrics, obstetrics, and patients with chronic kidney disease.
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Posen AK, Paloucek FP, Gimbar RP. Anion gap physiology and faults of the correction formula. Am J Health Syst Pharm 2021; 79:446-451. [PMID: 34788391 DOI: 10.1093/ajhp/zxab423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The anion gap is a calculated fundamental laboratory parameter used to identify and monitor acid-base disturbances. A recently popularized correction formula transforms the resulting integer to compensate for hypoalbuminemia and improve diagnostic yield. Clinical pharmacists should be aware of the underlying biochemistry, interpretation, and limitations of this formula to discern drug- and disease-related etiologies. SUMMARY The anion gap is utilized in most care settings, ranging from outpatient monitoring to inpatient intensive care units. Supported by decades of experience, the original anion gap derives its value from its simplicity. Applying the anion gap in metabolic acidosis can help narrow differential diagnosis and detect concomitant acid-base disorders. To account for hypoalbuminemia and potential missed diagnoses, a correction formula was developed to improve sensitivity. Yet, the law of electroneutrality ensures that hypoalbuminemia is already accounted for in the original anion gap, and the proposed correction formula was derived from samples unrepresentative of human physiology. Evidence from clinical trials shows no benefit from applying the correction formula. CONCLUSION There is no advantage to correcting the anion gap, and such correction may increase the risk of misinterpretation or error. Clinicians should understand these limitations when diagnosing or trending acid-base disturbances.
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Affiliation(s)
- Andrew K Posen
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Frank P Paloucek
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Renee Petzel Gimbar
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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Plasma Anion Gap and Risk of In-Hospital Mortality in Patients with Acute Ischemic Stroke: Analysis from the MIMIC-IV Database. J Pers Med 2021; 11:jpm11101004. [PMID: 34683145 PMCID: PMC8541378 DOI: 10.3390/jpm11101004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 02/06/2023] Open
Abstract
We aimed to investigate the association between the plasma anion gap (AG) and in-hospital mortality among patients with acute ischemic stroke (AIS). In total, 1236 AIS patients were enrolled using the Medical Information Mart for Intensive Care Database IV. Primary outcome was in-hospital mortality. The patients were divided into four groups according to AG category. The mean age and Charlson comorbidity index increased as the AG category increased. The fourth AG category was most related to the in-hospital mortality (hazards ratio (HR), 95% confidence interval (CI): 2.77, 1.60-4.71), even after adjusting for possible confounding variables (Model 1: HR, 95% CI: 3.37, 1.81-6.09; Model 2: HR, 95% CI: 3.57, 1.91-6.69). Moreover, intensive care unit mortality (p = 0.008) was higher in the highest AG category, but the intracranial hemorrhage (p = 0.071) did not associate with the plasma AG. The plasma AG had a satisfactory predictive ability for in-hospital mortality among AIS patients (areas under the receiver operating characteristic curve: 0.631). The plasma AG is an independent risk factor that can satisfactorily predict the in-hospital mortality among AIS patients.
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Hu T, Zhang Z, Jiang Y. Albumin corrected anion gap for predicting in-hospital mortality among intensive care patients with sepsis: A retrospective propensity score matching analysis. Clin Chim Acta 2021; 521:272-277. [PMID: 34303712 DOI: 10.1016/j.cca.2021.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relationship between albumin corrected anion gap (ACAG) and in-hospital mortality of intensive care sepsis patients is currently inconclusive. METHODS The baseline data, concentration of albumin, anion gap (AG), ACAG and in-hospital prognosis of intensive care patients with sepsis were retrieved from the Medical Information Mart for Intensive Care IV database. Propensity score matching (PSM) analysis was performed to reduce bias. Receiver operating characteristic curves were drawn for albumin, AG, and ACAG, and comparisons between the areas under the ROC curves were conducted. Decision curve analysis (DCA) was performed to determine the net benefit of ACAG. RESULTS ACAG was related to in-hospital mortality in intensive care patients with sepsis. The AUCs of ACAG were 0.689 (before PSM) and 0.644 (after PSM), which were significantly higher than that of albumin or AG. The Youden's index of ACAG was the highest, and the net benefit range of ACAG was also the largest according to the DCA. CONCLUSIONS ACAG has the highest predictive value for in-hospital mortality of intensive care patients with sepsis, which is better than albumin and AG. Using ACAG to predict the in-hospital mortality to guide clinical applications may obtain the highest net benefit.
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Affiliation(s)
- Tianyang Hu
- Department of Cardiology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhengwei Zhang
- Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, China
| | - Youfan Jiang
- Department of Respiration, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
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Sławuta P, Sikorska-Kopyłowicz A, Sapikowski G. Diagnostic utility of different models used to assess the acid-base balance in cats with chronic kidney disease. Acta Vet Hung 2020; 68:169-176. [PMID: 32857709 DOI: 10.1556/004.2020.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
Metabolic acidosis is diagnosed based on the concentration of bicarbonate ions and partial pressure of carbon dioxide in arterial blood, although acid-base balance (ABB) disorders may also be diagnosed based on the serum ion concentrations in order to determine the values of strong ion difference (SID), anion gap (AG), corrected anion gap (AGcorr) and chloride/sodium ratio (Cl-/Na+). The aim of this study was to assess and compare the classic model, the value of the AG, AGcorr, and Cl-/Na+ in the diagnosis of ABB disorders in cats with chronic kidney disease (CKD). The study group consisted of 80 cats with CKD, divided into four groups based on the guidelines of the International Renal Interest Society (IRIS). The control group (C) included 20 healthy cats. Metabolic acidosis - diagnosed based on the classic model (Hendersson-Hasselbalch equation) - was found in IRIS group IV. AG, AGcorr, SID calculated for IRIS groups II, III and IV were lower than in group C, while the value of AGdiff and Cl-/Na+ in those groups was higher than in group C. We can conclude that ABB analysis using the classic model enabled the detection of ABB disorders in cats in stage IV CKD. However, the analysis of the AG, AGcorr and Cl-/Na+ values enabled the diagnosis of acid-base balance disorders in cats with IRIS stage II, III and IV CKD.
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Affiliation(s)
- Piotr Sławuta
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
| | - Agnieszka Sikorska-Kopyłowicz
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
| | - Grzegorz Sapikowski
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
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Kwak HJ, Lim OK, Baik JM, Jo YY. Acid/base alterations during major abdominal surgery: 6% hydroxyethyl starch infusion versus 5% albumin. Korean J Anesthesiol 2018; 71:459-466. [PMID: 29684990 PMCID: PMC6283709 DOI: 10.4097/kja.d.18.27195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the effects of intraoperative infusions of balanced electrolyte solution (BES)-based hydroxyethyl starch (HES) and saline-based albumin on metabolic acidosis and acid/base changes during major abdominal surgery conducted using Stewart's approach. METHODS Forty patients, aged 20-65 years, undergoing major abdominal surgery, were randomly assigned to the HES group (n = 20; received 500 ml of BES-based 6% HES 130/0.4) or the albumin group (n = 20; received 500 ml of normal saline-based 5% albumin). Acid-base parameters were measured and calculated using results obtained from arterial blood samples taken after anesthesia induction (T1), 2 hours after surgery commencement (T2), immediately after surgery (T3), and 1 hour after arriving at a postanesthetic care unit (T4). RESULTS Arterial pH in the HES group was significantly higher than that in the albumin group at T3 (7.40 ± 0.04 vs. 7.38 ± 0.04, P = 0.043), and pH values exhibited significant intergroup difference over time (P = 0.002). Arterial pH was significantly lower at T3 and T4 in the HES group and at T2, T3, and T4 in the albumin group than at T1. Apparent strong ion difference (SIDa) was significantly lower at T2, T3, and T4 than at T1 in both groups. Total plasma weak nonvolatile acid (ATOT) was significantly lower in the HES group than in the albumin group at T2, T3 and T4 and exhibited a significant intergroup difference over time (P < 0.001). CONCLUSIONS BES-based 6% HES infusion was associated with lower arterial pH values at the end of surgery than saline-based 5% albumin infusion, but neither colloid caused clinically significant metabolic acidosis (defined as an arterial pH < 7.35).
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Affiliation(s)
- Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Myung Baik
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Kaneko M, Hagiwara S, Aoki M, Murata M, Nakajima J, Oshima K. The significance of strong ion gap for predicting return of spontaneous circulation in patients with cardiopulmonary arrest. Open Med (Wars) 2017; 12:33-38. [PMID: 28401198 PMCID: PMC5385977 DOI: 10.1515/med-2017-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/05/2017] [Indexed: 01/31/2023] Open
Abstract
Useful parameters that can predict return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) have not been established. We previously reported the usefulness of anion gap (AG) and albumin-corrected anion gap (ACAG) calculated from a blood sample obtained on arrival at the hospital for the prediction of ROSC. Otherwise, it has been reported that strong ion gap (SIG), which shows the difference between the levels of fully dissociated cations and anions in the serum, is useful to predict the prognosis of critically ill patients. This was a prospective and observational clinical study. Patients with CPA transferred to the emergency department of our hospital between January 2013 and December 2014 were evaluated. Patients were divided into two groups: patients who obtained ROSC [ROSC(+) group] and those who did not [ROSC(−) group]. We compared AG, ACAG and SIG between the two groups. A total of 170 patients were enrolled. Fifty patients were included in the ROSC(+) group, and the remaining 120 in the ROSC(−) group. Both AG and ACAG were significantly better in the ROSC(+) group; however, there was no significant difference in SIG between the two groups. The area under the receiver operating characteristic curves (AUC) for ROSC of both AG and ACAG were almost the same (0.72 and 0.708, respectively); the AUC of SIG (0.57) was inferior to those of AG and ACAG. Our results suggest that AG and ACAG can better predict ROSC following cardiopulmonary resuscitation (CPR) compared with SIG.
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Affiliation(s)
- Minoru Kaneko
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , 3-39-22 Showa-machi, Maebashi , Gunma 371-8511 , Japan , Tel&Fax: +81-27-220-8541
| | - Shuichi Hagiwara
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , Gunma , Japan
| | - Makoto Aoki
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , Gunma , Japan
| | - Masato Murata
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , Gunma , Japan
| | - Jun Nakajima
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , Gunma , Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine , Gunma University Graduate School of Medicine , Gunma , Japan
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Meddour M, Lemyze M, Thévenin D, Mallat J. Les utilisations du trou anionique plasmatique corrigé pour le diagnostic de l’acidose métabolique. MEDECINE INTENSIVE REANIMATION 2015; 24:713-720. [DOI: 10.1007/s13546-015-1097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Drug-induced acid-base disorders. Pediatr Nephrol 2015; 30:1407-23. [PMID: 25370778 DOI: 10.1007/s00467-014-2958-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal anti-inflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e.g., laxative drugs) mechanisms; (4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and (5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment (e.g., anesthetics, sedatives) or hyperventilation (e.g., salicylates, epinephrine, nicotine).
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Abstract
Severe burn injury produces significant tissue damage, resulting in metabolic acidosis. Current methods of acid-base evaluation are based on dependent variables that may not be accurate after burn injury. The strong ion method of acid-base evaluation is based on independent variables and may accurately predict outcomes in severely burn-injured patients. The authors hypothesize that an increased strong ion gap present on admission will be associated with mortality in severely burn-injured pediatric patients. A retrospective chart review was performed of burn-injured pediatric patients with a TBSA 20% or greater. Data collected included age, TBSA burn injury, mechanism of injury, survival, ventilator days, hospital length of stay, intensive care unit length of stay, and admission laboratory values. Apparent and effective strong ion difference (SIDa, SIDe) were calculated. The strong ion gap (SIG) was determined as the difference between SIDa and SIDe. A total of 48 patients were included in the study. Mean age (years) and TBSA were 7.9 ± 0.8 years and 56.8 ± 2.6%. Eleven patients (23%) died. Mean TBSA for survivors (54.2 ± 2.9%) did not significantly differ from that of nonsurvivors (65.7 ± 5.34%). Ten patients suffered inhalation injury, which was associated with an odds ratio of 10.1* for mortality. Mean SIDa was 44.2 ± 3.2 for the entire study population. Survivors had a significantly lower SIDa (36.6 ± 0.5) than nonsurvivors (59.7 ± 13*). Mean SIDe for all patients was (25 ± 0.7) and did not differ significantly between survivors (24.7 ± 0.7) and nonsurvivors (25.8 ± 2). SIG for nonsurvivors (33.91 ± 14*) was significantly higher than for survivors (14.9 ± 0.3). Controlling for both TBSA and inhalation injury, death was associated with both an increased SIDa (B = 19.3*) and SIG (B = 17.3*). SIG is increased in severely burn-injured pediatric patients, indicating the presence of metabolic acidosis. Furthermore, an increased SIG is significantly associated with mortality. (*P <.05.).
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Gezer M, Bulucu F, Ozturk K, Kilic S, Kaldirim U, Eyi YE. Effectiveness of the Stewart Method in the Evaluation of Blood Gas Parameters. Turk J Emerg Med 2015; 15:3-7. [PMID: 27437520 PMCID: PMC4909963 DOI: 10.5505/1304.7361.2014.73604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/21/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives In 1981, Peter A. Stewart published a paper describing his concept for employing Strong Ion Difference. In this study we compared the HCO3 levels and Anion Gap (AG) calculated using the classic method and the Stewart method. Methods Four hundred nine (409) arterial blood gases of 90 patients were collected retrospectively. Some were obtained from the same patients in different times and conditions. All blood samples were evaluated using the same device (ABL 800 Blood Gas Analyzer). HCO3 level and AG were calculated using the Stewart method via the website AcidBase.org. HCO3 levels, AG and strong ion difference (SID) were calculated using the Stewart method, incorporating the parameters of age, serum lactate, glucose, sodium, and pH, etc. Results According to classic method, the levels of HCO3 and AG were 22.4±7.2 mEq/L and 20.1±4.1 mEq/L respectively. According to Stewart method, the levels of HCO3 and AG were 22.6±7.4 and 19.9±4.5 mEq/L respectively. Conclusions There was strong correlation between the classic method and the Stewart method for calculating HCO3 and AG. The Stewart method may be more effective in the evaluation of complex metabolic acidosis.
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Affiliation(s)
- Mustafa Gezer
- Department of Internal Medicine, Mevki Military Hospital, Ankara, Turkey
| | - Fatih Bulucu
- Department of Internal Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kadir Ozturk
- Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Selim Kilic
- Department of Public Health, Gulhane Military Medical Academy, Ankara, Turkey
| | - Umit Kaldirim
- Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Yusuf Emrah Eyi
- Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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Masevicius FD, Dubin A. Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients? World J Crit Care Med 2015; 4:62-70. [PMID: 25685724 PMCID: PMC4326765 DOI: 10.5492/wjccm.v4.i1.62] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/29/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot). Accordingly, the pH and the bicarbonate levels (dependent variables) are only altered when one or more of the independent variables change. Moreover, the source of H+ is the dissociation of water to maintain electroneutrality when the independent variables are modified. The basic principles of the Stewart approach in blood, however, have been challenged in different ways. First, the presumed independent variables are actually interdependent as occurs in situations such as: (1) the Hamburger effect (a chloride shift when CO2 is added to venous blood from the tissues); (2) the loss of Donnan equilibrium (a chloride shift from the interstitium to the intravascular compartment to balance the decrease of Atot secondary to capillary leak; and (3) the compensatory response to a primary disturbance in either independent variable. Second, the concept of water dissociation in response to changes in SID is controversial and lacks experimental evidence. In addition, the Stewart approach is not better than the conventional method for understanding acid-base disorders such as hyperchloremic metabolic acidosis secondary to a chloride-rich-fluid load. Finally, several attempts were performed to demonstrate the clinical superiority of the Stewart approach. These studies, however, have severe methodological drawbacks. In contrast, the largest study on this issue indicated the interchangeability of the Stewart and conventional methods. Although the introduction of the Stewart approach was a new insight into acid-base physiology, the method has not significantly improved our ability to understand, diagnose, and treat acid-base alterations in critically ill patients.
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Hagiwara S, Kaneko M, Murata M, Aoki M, Nakajima J, Kanbe M, Ohyama Y, Tamura J, Oshima K. Study on the Effectiveness of Cardiopulmonary Resuscitation in Elderly Patients Presenting with Cardiopulmonary Arrest on Arrival. Intern Med 2015; 54:1859-63. [PMID: 26234225 DOI: 10.2169/internalmedicine.54.4476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study was conducted to determine whether a policy of not attempting to resuscitate patients who are 80 years of age and older with cardiopulmonary arrest on arrival is justifiable. METHODS The protocol of this study was approved without the need for informed consent by the research ethics board of Gunma University Hospital. We prospectively analyzed patients with cardiopulmonary arrest on arrival that was due to an intrinsic reason who were taken to Gunma University Hospital between January 2013 and March 2014. The patients were divided into two groups: patients who were less than 80 years of age (L group) and those aged 80 years and older (H group). We compared the patients' characteristics, including the etiology of cardiac arrest, and the prognosis between the two groups. RESULTS A total of 103 patients with cardiopulmonary arrest on arrival were enrolled. There were no significant differences in the patients' characteristics, such as age, sex, witness and bystander cardiopulmonary resuscitation, and transportation time between the two groups. The return of spontaneous circulation was obtained in 14 patients (25.5%) in the L group and in 9 patients (18.8%) in the H group; however, no significant difference was seen between the two groups. Two patients in the L group were in good neurological condition when they were discharged; however, the other patients did not survive. CONCLUSION Even patients 80 years of age and older can be resuscitated to spontaneous circulation. We do not endorse a policy that recommends not performing cardiopulmonary resuscitation based solely on the age of the patient.
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Affiliation(s)
- Shuichi Hagiwara
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan
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Hagiwara S, Murata M, Kaneko M, Aoki M, Kanbe M, Ohyama Y, Tamura J, Oshima K. Usefulness of serum fibrin degradation products and D-dimer levels as biomarkers to predict return of spontaneous circulation in patients with cardiopulmonary arrest on arrival: comparison with acid-base balance. Acute Med Surg 2014; 1:222-227. [PMID: 29930852 DOI: 10.1002/ams2.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/06/2014] [Indexed: 11/09/2022] Open
Abstract
Aim We evaluated the usefulness of fibrin degradation products and D-dimer levels in blood to predict return of spontaneous circulation in patients with cardiopulmonary arrest on arrival compared with anion gap and albumin-corrected anion gap. Methods We retrospectively reviewed the medical records of patients with cardiopulmonary arrest on arrival who had been transferred to the emergency department of our hospital in 2012. Patients were divided into two groups: patients with return of spontaneous circulation (ROSC(+) group), and those without (ROSC(-) group). The levels of anion gap, albumin-corrected anion gap, fibrin degradation products and D-dimer measured on arrival were compared between the two groups. Results Fifty-three patients could be analyzed. The anion gap and albumin-corrected anion gap levels were significantly better in the ROSC(+) group than in the ROSC(-) group (anion gap, 28.7 mmol/L [median] versus 39.1 mmol/L; albumin-corrected anion gap, 31.1 mmol/L versus 40.9 mmol/L). The fibrin degradation product and D-dimer levels were significantly lower in the ROSC(+) group than in the ROSC(-) group (fibrin degradation products, 32.1 μg/mL versus 157.4 μg/mL; D-dimer, 9.9 μg/mL versus 37.4 μg/mL). The area under receiver operating characteristic curves to evaluate the relationship with return of spontaneous circulation of anion gap, albumin-corrected anion gap, fibrin degradation products, and D-dimer were 0.664, 0.667, 0.714, and 0.707, respectively. Conclusion Fibrin degradation products and D-dimer levels might be more useful as predictors of return of spontaneous circulation than anion gap and albumin-corrected anion gap.
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Affiliation(s)
- Shuichi Hagiwara
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Masato Murata
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Minoru Kaneko
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Makoto Aoki
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Masahiko Kanbe
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Yoshio Ohyama
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan.,Department of General Medicine Gunma University Graduate School of Medicine Maebashi Japan
| | - Jun'ichi Tamura
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan.,Department of General Medicine Gunma University Graduate School of Medicine Maebashi Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
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Effect of the independent acid base variables on anion gap variation in cardiac surgical patients: a Stewart-Figge approach. ScientificWorldJournal 2014; 2014:907521. [PMID: 24688446 PMCID: PMC3932271 DOI: 10.1155/2014/907521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine the effect of each of independent acid base variables on the anion gap (AG) value in cardiac surgical patients. METHODS This retrospective study involved 128 cardiac surgical patients admitted for postoperative care. The variation of AG (AGvar) between the day of admission and the first postoperative day was correlated via a multiple linear regression model with the respective variations of the independent acid base variables, that is, apparent strong ion difference (SIDa), strong ion gap (SIG), carbon dioxide (PCO2), and albumin and phosphate concentrations. RESULTS The variations of all the above variables contributed significantly to the prediction of AGvar (adjusted R (2) = 0.9999, F = 201890.24, and P < 0.001). According to the standardized coefficients (β), SIGvar (β = 0.948, P < 0.001), [Albumin]var (β = 0.260, P < 0.001), and [Phosphate]var (β = 0.191, P < 0.001) were the major determinants of AGvar with lesser contributions from SIDa, var (β = 0.071, P < 0.001) and PCO2, var (β = -0.067, P < 0.001). CONCLUSIONS All the independent acid base variables contribute to the prediction of the AG value. However, albumin and phosphate and SIG variations seem to be the most important predictors, while AG appears to be rather stable with changes in PCO2 and SIDa.
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Sadjadi SA, Manalo R, Jaipaul N, McMillan J. Ion-selective electrode and anion gap range: What should the anion gap be? Int J Nephrol Renovasc Dis 2013; 6:101-5. [PMID: 23776389 PMCID: PMC3681403 DOI: 10.2147/ijnrd.s44689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Using flame photometry technique in the 1970s, the normal value of anion gap (AG) was determined to be 12 ± 4 meq/L. However, with introduction of the autoanalyzers using an ion-selective electrode (ISE), the anion gap value has fallen to lower levels. Methods A retrospective study of US veterans from a single medical center was performed to determine the value of the anion gap in subjects with normal renal function and normal serum albumin and in patients with lactic acidosis and end-stage renal disease on dialysis. Results In 409 patients with an estimated glomerular filtration rate ≥60 mL/min/1.73 m2 body surface area and serum albumin ≥4 g/dL, the mean AG was 7.2 ± 2 (range 3–11) meq/L. In 299 patients with lactic acidosis (lactate level ≥4 meq/L) and 68 patients with endstage renal disease on dialysis, the mean AG was 12.5 meq/L and 12.4 meq/L, respectively. A value <2 meq/L should be considered a low anion gap and a possible clue to drug intoxication and paraproteinemic disorders. Conclusion With the advent of ISE for measurement of analytes, the value of the anion gap has fallen. Physicians need to be aware of the normal AG value in their respective institutions, and laboratories need to have an established value for AG based on the type of instrument they are using.
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Affiliation(s)
- Seyed-Ali Sadjadi
- Jerry L Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Hagiwara S, Oshima K, Furukawa K, Nakamura T, Ohyama Y, Tamura JI. The significance of albumin corrected anion gap in patients with cardiopulmonary arrest. Ann Thorac Cardiovasc Surg 2012; 19:283-8. [PMID: 23232266 DOI: 10.5761/atcs.oa.12.01942] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The reliable parameter, which can be obtained easily and quickly, is necessary to predict the return of spontaneous circulation (ROSC) of patients with cardiopulmonary arrest (CPA) in the emergency situation. In this study, we evaluated the significance of albumin corrected anion gap (ACAG) for the prediction of ROSC in patients with CPA. PATIENTS AND METHODS In 166 patients with CPA between January 2009 and December 2010, 132 patients could be analyzed retrospectively. We compared acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment(SOFA) score, anion gap (AG) and ACAG levels between patients with/without ROSC and evaluated the significance of AG and ACAG to predict ROSC in patients with CPA. RESULTS Both AG and ACAG were significantly lower in patients with ROSC than in patients without ROSC. Both AG and ACAG had the relation with APACHE II and SOFA scores, however, coefficients of correlation with APACHE II and SOFA score were higher in ACAG (r = 0.506) than in AG (r = 0.482). The sensitivity, specificity, positive predictive value, and negative predictive value of ACAG for the prediction of ROSC in patients with CPA were better than those of AG. CONCLUSION Our study shows that both AG and ACAG have the relation with ROSC and ACAG is better to predict the ROSC following CPR in patients with CPA compared with AG. ACAG can be easily obtained in the emergency situation, and ACAG is a useful parameter to predict ROSC in patients with CPA.
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Affiliation(s)
- Shuichi Hagiwara
- Department of Emergency Medicine, Gunma University Gradu ate School of Medicine, Maebashi, Gunma, Japan
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Jeong RB, An JH, Jun HM, Jeong SM, Shin TY, Kim YS, Ha YR. Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.4.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ru-Bi Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jung-Hwan An
- Department of Emergency Medicine, Hallym University Hospital, Seoul, Korea
| | - Hyun-Min Jun
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sung-Min Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Tae-Yong Shin
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Young-Sik Kim
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Young-Rock Ha
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Chawla LS, Shih S, Davison D, Junker C, Seneff MG. Anion gap, anion gap corrected for albumin, base deficit and unmeasured anions in critically ill patients: implications on the assessment of metabolic acidosis and the diagnosis of hyperlactatemia. BMC Emerg Med 2008; 8:18. [PMID: 19087326 PMCID: PMC2644323 DOI: 10.1186/1471-227x-8-18] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 12/16/2008] [Indexed: 01/20/2023] Open
Abstract
Background Base deficit (BD), anion gap (AG), and albumin corrected anion gap (ACAG) are used by clinicians to assess the presence or absence of hyperlactatemia (HL). We set out to determine if these tools can diagnose the presence of HL using cotemporaneous samples. Methods We conducted a chart review of ICU patients who had cotemporaneous arterial blood gas, serum chemistry, serum albumin (Alb) and lactate(Lac) levels measured from the same sample. We assessed the capacity of AG, BD, and ACAG to diagnose HL and severe hyperlactatemia (SHL). HL was defined as Lac > 2.5 mmol/L. SHL was defined as a Lac of > 4.0 mmol/L. Results From 143 patients we identified 497 series of lab values that met our study criteria. Mean age was 62.2 ± 15.7 years. Mean Lac was 2.11 ± 2.6 mmol/L, mean AG was 9.0 ± 5.1, mean ACAG was 14.1 ± 3.8, mean BD was 1.50 ± 5.4. The area under the curve for the ROC for BD, AG, and ACAG to diagnose HL were 0.79, 0.70, and 0.72, respectively. Conclusion AG and BD failed to reliably detect the presence of clinically significant hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility.
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Affiliation(s)
- Lakhmir S Chawla
- Department of Critical Care Medicine and Anesthesiology, George Washington University Medical Center, Washington, DC, USA.
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de Morais HA, Bach JF, DiBartola SP. Metabolic acid-base disorders in the critical care unit. Vet Clin North Am Small Anim Pract 2008; 38:559-74, x-xi. [PMID: 18402881 DOI: 10.1016/j.cvsm.2008.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The recognition and management of acid-base disorders is a commonplace activity in the critical care unit, and the role of weak and strong acids in the genesis of metabolic acid-base disorders is reviewed. The clinical approach to patients with metabolic alkalosis and metabolic acidosis is discussed in this article.
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Affiliation(s)
- Helio Autran de Morais
- Department of Medical Sciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Chawla LS, Jagasia D, Abell LM, Seneff MG, Egan M, Danino N, Nguyen A, Ally M, Kimmel PL, Junker C. Anion gap, anion gap corrected for albumin, and base deficit fail to accurately diagnose clinically significant hyperlactatemia in critically ill patients. J Intensive Care Med 2008; 23:122-7. [PMID: 18431828 DOI: 10.1177/0885066607312985] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anion gap, anion gap corrected for serum albumin, and base deficit are often used as surrogates for measuring serum lactate. None of these surrogates is postulated to predict hyperlactatemia in the critically ill. We prospectively collected data from September 2004 through August 2005 for 1381 consecutive admissions. Patients with renal disease, ketoacidosis, or toxic ingestion were excluded. Anion gap, anion gap corrected for albumin, and base deficit were calculated for all patients. We identified 286 patients who met our inclusion or exclusion criteria. The receiver-operating characteristic area under the curve for the prediction of hyperlactatemia for anion gap, anion gap corrected for albumin, and base deficit were 0.55, 0.57, and 0.64, respectively. Anion gap, anion gap corrected for albumin, and base deficit do not predict the presence or absence of clinically significant hyperlactatemia. Serum lactate should be measured in all critically ill adults in whom hypoperfusion is suspected.
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Affiliation(s)
- Lakhmir S Chawla
- Department of Critical Care Medicine and Anesthesiology, The George Washingto Unitversity Medical Center, Washington, DC, USA
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Tuhay G, Pein MC, Masevicius FD, Kutscherauer DO, Dubin A. Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches. Crit Care 2008; 12:R66. [PMID: 18466618 PMCID: PMC2481449 DOI: 10.1186/cc6896] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/28/2008] [Accepted: 05/08/2008] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Critically ill patients might present complex acid-base disorders, even when the pH, PCO2, [HCO3-], and base excess ([BE]) levels are normal. Our hypothesis was that the acidifying effect of severe hyperlactatemia is frequently masked by alkalinizing processes that normalize the [BE]. The goal of the present study was therefore to quantify these disorders using both Stewart and conventional approaches. METHODS A total of 1,592 consecutive patients were prospectively evaluated on intensive care unit admission. Patients with severe hyperlactatemia (lactate level > or = 4.0 mmol/l) were grouped according to low or normal [BE] values (<-3 mmol/l or >-3 mmol/l). RESULTS Severe hyperlactatemia was present in 168 of the patients (11%). One hundred and thirty-four (80%) patients had low [BE] levels while 34 (20%) patients did not. Shock was more frequently present in the low [BE] group (46% versus 24%, P = 0.02) and chronic obstructive pulmonary disease in the normal [BE] group (38% versus 4%, P < 0.0001). Levels of lactate were slightly higher in patients with low [BE] (6.4 +/- 2.4 mmol/l versus 5.6 +/- 2.1 mmol/l, P = 0.08). According to our study design, the pH, [HCO3-], and strong-ion difference values were lower in patients with low [BE]. Patients with normal [BE] had lower plasma [Cl-] (100 +/- 6 mmol/l versus 107 +/- 5 mmol/l, P < 0.0001) and higher differences between the changes in anion gap and [HCO3-] (5 +/- 6 mmol/l versus 1 +/- 4 mmol/l, P < 0.0001). CONCLUSION Critically ill patients may present severe hyperlactatemia with normal values of pH, [HCO3-], and [BE] as a result of associated hypochloremic alkalosis.
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Affiliation(s)
- Graciela Tuhay
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
| | - María Carolina Pein
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
| | | | | | - Arnaldo Dubin
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
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Dubin A, Menises MM, Masevicius FD, Moseinco MC, Kutscherauer DO, Ventrice E, Laffaire E, Estenssoro E. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit Care Med 2007; 35:1264-70. [PMID: 17334252 DOI: 10.1097/01.ccm.0000259536.11943.90] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Stewart approach states that pH is primarily determined by Pco2, strong ion difference (SID), and nonvolatile weak acids. This method might identify severe metabolic disturbances that go undetected by traditional analysis. Our goal was to compare diagnostic and prognostic performances of the Stewart approach with a) the traditional analysis based on bicarbonate (HCO3) and base excess (BE); and b) an approach relying on HCO3, BE, and albumin-corrected anion gap (AGcorrected). DESIGN Prospective observational study. SETTING A university-affiliated hospital intensive care unit (ICU). PATIENTS Nine hundred thirty-five patients admitted to the ICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The Stewart approach detected an arterial metabolic alteration in 131 (14%) of patients with normal HCO3- and BE, including 120 (92%) patients with metabolic acidosis. However, 108 (90%) of these patients had an increased AGcorrected. The Stewart approach permitted the additional diagnosis of metabolic acidosis in only 12 (1%) patients with normal HCO3, BE, and AGcorrected. On the other hand, the Stewart approach failed to identify 27 (3%) patients with alterations otherwise observed with the use of HCO3-, BE, and AGcorrected (16 cases of acidosis and 11 of alkalosis). SID and BE, and strong ion gap (SIG) and AGcorrected, were tightly correlated (R2 = .86 and .97, p < .0001 for both) with narrow 95% limits of agreement (8 and 3 mmol/L, respectively). Areas under receiver operating characteristic curves to predict 30-day mortality were 0.83, 0.62, 0.61, 0.60, 0.57, 0.56, and 0.67 for Sepsis-related Organ Failure Assessment (SOFA) score, SIG, AGcorrected, SID, BE, HCO3-, and lactates, respectively (SOFA vs. the rest, p < .0001). CONCLUSIONS In this large group of critically ill patients, diagnostic performance of the Stewart approach exceeded that of HCO3- and BE. However, when AGcorrected was included in the analysis, the Stewart approach did not offer any diagnostic or prognostic advantages.
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Affiliation(s)
- Arnaldo Dubin
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
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