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

Ji, Xuan; Peng, Shixuan

doi:10.1002/jcla.24818

Cited by 8 publications

(7 citation statements)

References 38 publications

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“… 9 An elevated level of AG increases all-cause mortality in unselected adults. 10 Moreover, AG can predict short-time prognosis for cerebral infarction patients. 11 Although the specific mechanisms were not well understood and explained.…”

Section: Discussionmentioning

confidence: 99%

Albumin Corrected Anion Gap and the Risk of in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study

Li¹,

Shi²,

Yan³

et al. 2023

JIR

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Purpose To explore the prognostic value of albumin corrected anion gap (ACAG) within 24 hours of admission to the intensive care unit (ICU) for acute pancreatitis (AP). Patients and Methods This was a retrospective cohort study. Adult AP patients admitted to ICU from June 2016 to December 2019 were included in the study, who were divided into three groups according to initial serum ACAG within 24 hours upon ICU admission: ACAG ≤ 14.87 mmol/L, 14.87 < ACAG ≤ 19.03 mmol/L, and ACAG > 19.03 mmol/L. The primary study outcome indicator was in-hospital mortality. Age, sex, Glasgow Coma Scale score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched through propensity score matching (PSM) method to balance the baseline between the survivors and non-survivors. Multivariate Cox regression was used to determine the relationship between ACAG and in-hospital mortality. Results A total of 344 patients (of them 81 non-survivors) were analyzed in this study. Patients with higher ACAG intended to present significantly higher in-hospital mortality, APACHE II score, creatine, lower albumin, and bicarbonate. Multivariate Cox regression analysis after matching demonstrated that white blood cell count, platelet count, and higher ACAG were independently associated with higher in-hospital mortality (ACAG ≤ 14.87 as a reference, 14.87 < ACAG ≤ 19.03 mmol/L with HR of 2.34 and 95% CI of 1.15–4.76, ACAG >19.03 with HR of 3.46 and 95% CI of 1.75–6.84). Conclusion Higher ACAG was independently associated with higher in-hospital mortality in patients with AP after matching the baseline between the survivors and non-survivors.

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Section: Discussionmentioning

confidence: 99%

Albumin Corrected Anion Gap and the Risk of in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study

Li¹,

Shi²,

Yan³

et al. 2023

JIR

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“…Meanwhile, studies have suggested that there was a correlation between AG and the prognosis of surgical patients 26,27 . Recently, a study conducted on unselected adult patients suggested that higher levels of serum AG were positively associated with all‐cause mortality 28 . Furthermore, an increase in serum AG levels is correlated with an increased risk of patient mortality.…”

Section: Discussionmentioning

confidence: 99%

“… 26 , 27 Recently, a study conducted on unselected adult patients suggested that higher levels of serum AG were positively associated with all‐cause mortality. 28 Furthermore, an increase in serum AG levels is correlated with an increased risk of patient mortality. It seems that AG is a highly promising indicator.…”

Section: Discussionmentioning

confidence: 99%

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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“…These studies have demonstrated associations in populations such as patients with cardiogenic shock, cardiac disease, post–cardiac arrest complications, disseminated intravascular coagulation, postoperative status, and advanced kidney disease. Ji and Peng demonstrated a positive correlation between serum anion gap values and all-cause mortality among unselected adult patients using only the MIMIC-III database [ 22 ]. While many studies have concentrated on specific patient groups and relied on single databases or a limited set of covariates, our research has delved into the association between the anion gap (including the corrected anion gap) and in-hospital mortality among general ICU patients.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of serum anion gaps with in-hospital mortality: Analysis of the multi-open databases

Yang,

Jo,

Lee

et al. 2024

PLoS ONE

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Background Few studies have investigated the relationship between the anion gap, including the corrected anion gap, and patient mortality in intensive care units (ICUs) without restricting the analysis to specific diseases or medical specialties. Our primary objective was to investigate the association between the anion gap and ICU mortality using multiple open-access databases. Methods We identified 4229 subjects from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, whose entries were from between 2008 and 2019. For each patient, the anion gap and corrected anion gap were calculated, and the study sample was divided into tertile groups (T) according to these levels. The association between the anion gap and in-hospital mortality was assessed using hazard ratios (HRs) and 95% confidence intervals (CIs) derived from a multivariable-adjusted Cox proportional hazards model. Besides MIMIC-IV, we also incorporated study samples from two other databases (MIMIC-III and electronic ICU) to calculate summary HRs using a random-effects meta-analysis. Results Within MIMIC-IV, 1015 patients (24%) died during an average follow-up period of 15.5 days. The fully adjusted HRs and 95% CIs for T2 and T3, relative to T1, were 1.31 (95% CI 1.08–1.58) and 1.54 (95% CI 1.24–1.90), respectively. When grouped by corrected anion gap, the results remained statistically significant. In the meta-analysis, the summary HRs and 95% CIs for T2 and T3 were 1.24 (95% CI 1.08–1.43) and 1.55 (95% CI 1.33–1.82), respectively. Conclusions Both the anion gap and corrected anion gap were associated with in-hospital mortality regardless of specific diseases or medical specialties.

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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

Cited by 8 publications

References 38 publications

Albumin Corrected Anion Gap and the Risk of in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study

Albumin Corrected Anion Gap and the Risk of in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study

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

Dynamics of serum anion gaps with in-hospital mortality: Analysis of the multi-open databases

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