Lactate, bicarbonate and anion gap for evaluation of patients presenting with sepsis to the emergency department: A prospective cohort study

Mitra, Biswadev; Roman, Cristina; Charters, Kate E.; O’Reilly, Gerard; Gantner, Dashiell; Cameron, Peter

doi:10.1111/1742-6723.13324

Cited by 33 publications

(30 citation statements)

References 18 publications

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“…In recent years, many studies have confirmed that elevated SAG is closely associated with poor prognosis in various diseases, including acute pesticide poisoning [ 15 ], sepsis [ 16 ], acute and chronic kidney injury [ 17 , 18 ], and coronary artery disease [ 19 ]. In a large study, it was shown that increased SAG may be of prognostic significance, as higher levels of AG were associated with hypertension [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Higher Serum Anion Gap Is Associated with the Risk of Progressing to Impaired Fasting Glucose and Diabetes

Zhang

Xiong

Zhao

et al. 2021

International Journal of Endocrinology

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Impaired fasting glucose (IFG) is a reversible intermediate hyperglycemia stage with an increasing risk of diabetes and related complications. Our study was designed to identify the relationship between the serum anion gap and the risk of progressing to impaired fasting glucose and diabetes. Here, we performed a prospective, population-based study among 1191 Chinese individuals aged 22–87 years who took health examinations annually between 2006 and 2012 including clinical features and plasma metabolites. All of the participants had no history of diabetes or related chronic complications. Logistic regression analysis was designed to examine the associations between clinical and metabolomic factors and the risk of developing IFG or diabetes. Among them, 58 subjects whose fasting glucose were between 6.1 and 7 mmol/L were diagnosed as IFG or diabetes. After adjusting for age, sex, body mass index (BMI), high-density lipoprotein (HDL), low-density lipoprotein (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium, and albumin at baseline, the participants in the upper tertiles of serum anion gap (SAG) had higher odds of progressing to IFG or diabetes than those in the lower tertiles. A receiver operating characteristic (ROC) curve was analyzed, and the optimal cutoff level for the anion gap to predict incident IFG or diabetes was 13.76 mmol/L, and the area under the ROC curve (AUC) was 0.623. Our data demonstrate that a higher serum anion gap is associated with the risk of developing IFG or diabetes.

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Section: Discussionmentioning

confidence: 99%

A Higher Serum Anion Gap Is Associated with the Risk of Progressing to Impaired Fasting Glucose and Diabetes

Zhang

Xiong

Zhao

et al. 2021

International Journal of Endocrinology

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“…Bicarbonate and anion gap were associated with higher mortality in sepsis patients even if lactate levels were low 10 . Metabolic acidosis at admission to ICU and early pH changes correlated with higher mortality in a small Indian cohort of critically ill patients 11 .…”

Section: Introductionmentioning

confidence: 93%

Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients

Schork

Moll

Haap

et al. 2021

Preprint

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Introduction: As base excess (BE) had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and Methods: For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality. Results: Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. Discussion: Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.

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“…It indicates the concentration of fixed acids in plasma, and it is a commonly used and easily obtained laboratory parameter of acid-base imbalance [5]. Some recent studies have confirmed that SAG is elevated and closely associated with poor prognosis of various diseases, including acute pesticide poisoning [6], sepsis [7], acute and chronic kidney injury [8,9], trauma [10], and coronary artery disease [11]. However, whether the anion gap could be used as a prognostic marker for critically ill patients with CHF remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Serum Anion Gap Is Associated with All-Cause Mortality among Critically Ill Patients with Congestive Heart Failure

et al. 2020

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Background. Congestive heart failure (CHF) is a complex clinical syndrome, with high morbidity and mortality. Serum anion gap (SAG) is associated with the severity of various cardiovascular diseases. However, the role of SAG indicators in CHF is unclear. Methods and Results. A retrospective analysis of data from Multiparameter Intelligent Monitoring in Intensive Care III version 1.4 was conducted in critically ill patients with CHF. The clinical information of each patient, including demographic data, comorbidities, vital signs, scores, and laboratory indicators, were successfully obtained. Cox proportional hazards models were used to determine the relationship between SAG and mortality in patients with CHF, the consistency of which was further verified by subgroup analysis. Results. A total of 7426 subjects met the inclusion criteria. Multivariate analysis showed that after adjusting for age, gender, ethnicity, and other potential confounders, increased SAG was significantly related to an increase in 30- and 90-day all-cause mortalities of critically ill patients with CHF compared with decreased SAG (tertile 3 versus tertile 1: adjusted hazard ratio, 95% confidence interval: 1.74, 1.46–2.08; 1.53, 1.32–1.77). Subgroup analysis indicated that the association between SAG and all-cause mortality presented similarities in most strata. Conclusion. SAG at admission could be a promising predictor of all-cause mortality in critically ill patients with CHF.

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Lactate, bicarbonate and anion gap for evaluation of patients presenting with sepsis to the emergency department: A prospective cohort study

Cited by 33 publications

References 18 publications

A Higher Serum Anion Gap Is Associated with the Risk of Progressing to Impaired Fasting Glucose and Diabetes

A Higher Serum Anion Gap Is Associated with the Risk of Progressing to Impaired Fasting Glucose and Diabetes

Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients

Serum Anion Gap Is Associated with All-Cause Mortality among Critically Ill Patients with Congestive Heart Failure

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