The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy

Abstract

The relationship between albumin corrected anion gap (ACAG) and mortality in acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) has not been investigated in any previous studies. This study aimed to investigate the relationship between ACAG at CRRT initiation and all-cause mortality among these patients in the intensive care unit (ICU). Patients diagnosed with AKI and treated with CRRT in the ICU from the Medical Information Mart for Intensive Care-IV version 1.0 (MIMIC IV) database and Huzhou Central Hospital were retrospectively enrolled. Participants were divided into two groups: the normal ACAG group (12-20 mmol/L) and high ACAG group (> 20 mmol/L). The Kaplan-Meier method and log-rank test were used to compare the survival rate between the two groups. Restricted cubic spine (RCS) and Cox proportional-hazards models were utilized to analyze the relationship between ACAG at CRRT initiation and ICU all-cause mortality of these patients. A total of 708 patients met the inclusion criteria in the study. The all-cause mortality of these patients during ICU hospitalization was 41.95%. Patients in the high ACAG group exhibited significantly higher ICU all-cause mortality rate than patients in the normal ACAG group (all P < 0.001). The Kaplan-Meier survival curves showed that the normal ACAG group had a higher ICU cumulative survival rate than the high ACAG group (log-rank test, χ 1 2 = 13.620, χ 2 2 = 12.460, both P < 0.001). In the multivariate COX regression analyses, patients with higher ACAG (> 20 mmol/L) levels at the time of CRRT initiation in the MIMIC IV database and Huzhou Central Hospital were significantly correlated with ICU all-cause mortality after adjusting multiple potential confounding factors with hazard ratios of 2.852 (95% CI 1.718-4.734) and 2.637(95% CI 1.584-4.389), respectively. In critically AKI patients who undergo CRRT, higher ACAG (> 20 mmol/L) level at the initiation of CRRT was significantly correlated with ICU all-cause mortality. Therefore, clinicians should pay more attention to those patients with a higher ACAG value.

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

“…ACAG is albumin-corrected AG, which can relatively improve the diagnostic sensitivity of metabolic acidosis and the predictive value for prognosis in ICU patients. Therefore, some scholars have proposed that ACAG is a (13).The current evidence suggested that elevated ACAG (>20 mmol/L) at the initiation of continuous renal replacement therapy (CRRT) was associated with ICU all-cause mortality in AKI patients who underwent CRRT, and ACAG can serve as an early indicator of adverse outcomes for these patients (14). In 2013, a study by Hagiwara et al had concluded that ACAG was more accurate in predicting ROSC in patients with CA.…”

“…At present, many scholars have initiated to explore the relationship between ACAG and outcomes of patients with different diseases. Hu et al found that ACAG (>21.25 mmol/L) could predict the risk of in-hospital mortality in ICU patients with sepsis, and the predictive value of ACAG was superior to AG and albumin ( 13 ).The current evidence suggested that elevated ACAG (>20 mmol/L) at the initiation of continuous renal replacement therapy (CRRT) was associated with ICU all-cause mortality in AKI patients who underwent CRRT, and ACAG can serve as an early indicator of adverse outcomes for these patients ( 14 ). In 2013, a study by Hagiwara et al had concluded that ACAG was more accurate in predicting ROSC in patients with CA.…”

“…Many scholars are still committed to looking for predictors of disease prognosis, so that the prognosis of patients can be judged in many ways. ACAG is a new inflammatory index, which has been found to be related to the prognosis of many diseases, such as AKI, sepsis and so on ( 13 , 14 ). Our research results have complemented the previous research on ACAG and found that high ACAG was an independent risk factor for poor prognosis in patients with CA.…”

“…ACAG has been reported to be associated with outcomes in patients with sepsis ( 13 ) and kidney disease ( 14 ). Elevated ACAG (>21.25 mmol/L) can increase the mortality of patients with sepsis in ICU ( 15 ).…”

Predictive value of the serum anion gap for 28-day in-hospital all-cause mortality in sepsis patients with acute kidney injury: a retrospective analysis of the MIMIC-IV database

“…In a recent retrospective propensity score-matching analysis, Hu et al reported that albumin-corrected AG had a high predictive value for the risk of death of septic patients during hospitalization ( 26 ). In another albumin-corrected AG study, the authors observed that in critically ill AKI patients receiving continuous renal replacement therapy (CRRT), a higher albumin-corrected AG (>20 mmol/L) level at the beginning of CRRT was significantly associated with all-cause mortality in the ICU ( 27 ). In this study, we did not use albumin correction to simplify the use of AG.…”