Strong ion gap in cardiogenic shock—the calculation seems wrong

Gatz, Rainer

doi:10.3109/17482941.2013.859270

Cited by 3 publications

(2 citation statements)

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“…There were also studies showing that SIG or SIDe could be better than BE, AG or lactate in predicting outcomes of critically ill patients [ 5 , 6 , 19 – 22 ]. However, many of these studies are relatively small, with the two largest studies (involving 410 and 935 patients) both showing an insignificant advantage by using SIG and SIDe instead of standard markers of acid-base disturbances in predicting mortality of critically ill patients [ 3 , 23 , 24 ]. To the best of our knowledge, this is the largest study ( n = 6878) assessing the prognostic significance of SIG (with and without including lactate) relative to 10 other acid-base markers in a heterogeneous group of critically ill patients, and our findings are consistent with the data from two largest published studies [ 3 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study

Lan

Williams

et al. 2016

j intensive care

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BackgroundThis cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill.MethodsThe relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC).ResultsOf the 6878 patients included in the study, 924 patients (13.4 %) died after ICU admission. Except for plasma chloride concentrations, all acid-base markers were significantly different between the survivors and non-survivors. SIG (with lactate: AUROC 0.631, confidence interval [CI] 0.611–0.652; without lactate: AUROC 0.521, 95 % CI 0.500–0.542) only had a modest ability to predict hospital mortality, and this was no better than using lactate concentration alone (AUROC 0.701, 95 % 0.682–0.721). Adding AG-corrected or SIG to a combination of lactate and MPM0 III predicted risks also did not substantially improve the latter’s ability to differentiate between survivors and non-survivors. Arterial lactate concentrations explained about 11 % of the variability in the observed mortality, and it was more important than SIG (0.6 %) and SIDe (0.9 %) in predicting hospital mortality after adjusting for MPM0 III predicted risks. Lactate remained as the strongest predictor for mortality in a sensitivity multivariate analysis, allowing for non-linearity of all acid-base markers.ConclusionsThe prognostic significance of SIG was modest and inferior to arterial lactate concentration for the critically ill. Lactate concentration should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study

Lan

Williams

et al. 2016

j intensive care

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“…Arterial pH and arterial base excess appeared to be more strongly associated with in-hospital mortality than bicarbonate or anion gap, suggesting that an arterial blood gas measurement may facilitate risk stratification for CS patients. The role of the anion gap versus the strong ion gap for prognostication in CS patients remains controversial, and our analysis did not examine the latter (17,35). Importantly, the bicarbonate level, base excess/deficit, anion gap, and strong ion gap all reflect overlapping pathophysiological processes, and to some extent function as surrogate markers for the severity of lactic acidosis.…”

Section: Discussionmentioning

confidence: 99%

Laboratory Markers of Acidosis and Mortality in Cardiogenic Shock: Developing a Definition of Hemometabolic Shock

Jentzer

Kashani

Wiley

et al. 2021

Shock

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Background: Acidosis and higher lactate predict worse outcomes in cardiogenic shock (CS) patients. We sought to determine whether overall acidosis severity on admission predicted in-hospital mortality in CS patients. Methods: This retrospective descriptive analysis included CS patients admitted to a single academic tertiary cardiac intensive care unit from 2007 to 2015. Admission arterial pH, base excess, and anion gap values were used to generate a Composite Acidosis Score (range 0-5, with a score !2 defining Severe Acidosis). Adjusted in-hospital mortality was analyzed using multivariable logistic regression. Results: We included 1,065 patients with median age of 68.9 (59.0, 77.2) years (36.4% females). Concomitant diagnoses included cardiac arrest in 38.1% and acute coronary syndrome in 59.1%. Severe Acidosis was present in 35.2%, and these patients had worse shock and more organ failure. In-hospital mortality occurred in 34.1% and was higher among patients with Severe Acidosis (54.9% vs. 22.4%, adjusted odds ratio [OR] 2.01, 95% CI 1.43-2.83, P < 0.001). Increasing Composite Acidosis Score was associated with higher in-hospital mortality (adjusted OR 1.25 per point, 95% CI 1.11-1.40, P < 0.001). Severe Acidosis was associated with higher hospital mortality at every level of shock severity and organ failure (all P < 0.05). Admission lactate level had equivalent discrimination for inhospital mortality as the Composite Acidosis Score (0.69 vs. 0.66; P ¼ 0.32 by De Long test). Conclusion: Given its incremental association with higher in-hospital mortality among CS patients beyond shock severity and organ failure, we propose Severe Acidosis as a marker of hemometabolic shock. Lactate levels performed as well as a composite measure of acidosis for predicting mortality.

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