The association between anion gap and in-hospital mortality of post-cardiac arrest patients: a retrospective study

Dai, Chuxing; Yang, Yang; Wang, Yimin; Zeng, Rui; Li, Bo; Liu, Qiang

doi:10.1038/s41598-022-11081-3

Cited by 17 publications

(26 citation statements)

References 33 publications

(24 reference statements)

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“…The relationship between elevated serum AG levels and the prognosis of associated disorders has recently been supported by numerous studies 6–14 . High serum AG levels were discovered to be an independent risk factor for death at 30 d and 90 d in patients with congestive heart failure in a recent study by Tang Y et al 25 utilizing data from the MIMIC‐III database.…”

Section: Discussionmentioning

confidence: 92%

“…24 The relationship between elevated serum AG levels and the prognosis of associated disorders has recently been supported by numerous studies. [6][7][8][9][10][11][12][13][14] High serum AG levels were discovered to be an independent risk factor for death at 30 d and 90 d in patients with congestive heart failure in a recent study by Tang Y et al 25 utilizing data from the MIMIC-III database. Similar results were reported in a study by Gong Y et al 26 who discovered a non-linear, U-shaped relationship between AG levels and 30-day all-cause mortality in AKI patients.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14] Numerous researchers have found that the higher the serum AG value, the higher the mortality rate and the worse the prognosis of patients. [6][7][8][9][10][11][12][13][14] Further studies have found that serum AG is of good clinical value in the identification of critical illnesses and the assessment of prognosis. 15,16 However, there are few studies on the prognosis of unselected adult patients and even fewer studies on the serum anion gap and long-term mortality.…”

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confidence: 99%

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The association between serum anion gap and all‐cause mortality of unselected adult patients: A retrospective cohort study of >20,000 patients

Peng

2022

Clinical Laboratory Analysis

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Background Even though the serum anion gap (AG) is frequently measured in clinical practice, there is not much research that has examined long‐term mortality in unselected adult patients. Our study's objective was to investigate how serum anion gap levels could be used to predict death in unselected participants. Methods The relationship between baseline serum AG levels and short‐, intermediate‐, and long‐term all‐cause mortality in unselected adult patients is examined using the Cox proportional risk analysis, smoothed curve fitting, subgroup analysis, and Kaplan–Meier survival curves. Results After screening the database using the appropriate method, a total of 26,270 patients were enrolled in our study for the final data analysis. Our study used smoothed curve fit plots and COX proportional risk regression models incorporating cubic spline functions to evaluate the association between AG levels and all‐cause mortality in a non‐selected population, and the results indicated a non‐linear relationship. In the fully adjusted model, we found that AG levels were positively associated with 30‐day, 90‐day, 365‐day, and 4‐year all‐cause mortality in unselected adult patients with HRs of 1.08 95% CIs (1.06, 1.09); 1.08 95% CIs (1.06, 1.09); 1.08 95% CIs (1.07, 1.08); 1.07 95% CIs (1.06, 1.07). Conclusion Serum anion gap levels were positively correlated with all‐cause mortality in unselected adult patients, with increasing levels of serum anion gap increasing patient mortality.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The association between serum anion gap and all‐cause mortality of unselected adult patients: A retrospective cohort study of >20,000 patients

Peng

2022

Clinical Laboratory Analysis

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“…As a traditional index of acid-base balance, AG may be a prognostic maker to predict outcomes. Previous studies demonstrated that AG was related to mortality of many cardiovascular diseases ( 6 , 9 , 15 ) and patients with elevated AG showed worse cardiac ( 16 ) and renal functions ( 17 ). These evidences suggested that AG might be an indicator of severe disease states.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative acid-base imbalance and electrolyte disturbances are common in patients who underwent cardiac surgery ( 18 ). Under cardiopulmonary bypass, hypoxia, ischemia, and acidosis occur frequently, which promote increased acidic substance and thus elevate AG levels ( 15 ). AG may indicate the status of hypoperfusion by reflecting the cumulative levels of acidic substance due to ischemia; while hemodynamic instability like hypotension is demonstrated to be associated with prognosis.…”

Section: Discussionmentioning

confidence: 99%

Postoperative anion gap associates with short- and long-term mortality after cardiac surgery: A large-scale cohort study

Tian

Wang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo investigate whether postoperative anion gap (AG) is associated with short- and long-term mortality in patients following cardiac surgery.Materials and methodsWe conducted a retrospective cohort study of adults who underwent cardiac surgery from the Medical Information Mart for Intensive Care - III database. The generalized additive model (GAM), logistic regression, and Cox regression were performed to assess the correlations between AG levels and in-hospital, 90-day, and 4-year mortality. Linear regression was used to evaluate the associations between AG and length of stay (LOS).ResultsTotally, 6,410 subjects were enrolled in this study and classified into tertiles based on the initial AG levels. The GAM indicated a positive association between initial AG and in-hospital mortality after adjusting for potential confounders. Multivariate logistic analysis revealed that the risk of in-hospital mortality was higher among patients in tertile 2 (OR 2.05, 95% CI 1.11–3.76, P = 0.021) and tertile 3 (OR 4.51, 95% CI 2.57–7.91, P < 0.001) compared with those in tertile 1. For 90-day and 4-year mortality, multivariate Cox regression found similar associations between AG tertiles and mortality. The LOS in ICU and hospital also increased as AG tertiles increased. The E-value indicated robustness to unmeasured confounders.ConclusionThis study found a positive association between postoperative AG levels and short- and long-term mortality among patients after cardiac surgery. This relationship warrants further research.

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The correlation between albumin‐corrected anion gap and prognosis in patients with acute myocardial infarction

Sheng,

Lu,

Zhong

et al. 2024

ESC Heart Failure

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AimsAcute 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 resultsData 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.ConclusionsElevated 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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The association between anion gap and in-hospital mortality of post-cardiac arrest patients: a retrospective study

Cited by 17 publications

References 33 publications

The association between serum anion gap and all‐cause mortality of unselected adult patients: A retrospective cohort study of >20,000 patients

The association between serum anion gap and all‐cause mortality of unselected adult patients: A retrospective cohort study of >20,000 patients

Postoperative anion gap associates with short- and long-term mortality after cardiac surgery: A large-scale cohort study

The correlation between albumin‐corrected anion gap and prognosis in patients with acute myocardial infarction

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