Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury

Zheng, Cai Mei; Liu, Wen-Chih; Zheng, Jun; Liao, Min; Wen, Ya; Hung, Kuo-Chin; Lu, Chien Lin; Wu, Chia‐Chao; Lu, Kuo Cheng

doi:10.1155/2014/819528

Cited by 25 publications

(15 citation statements)

References 24 publications

(25 reference statements)

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“…For patients with STEMI, AG was proved to be an independent risk factor for high inhospital mortality after percutaneous coronary intervention and could be used for risk stratification [ 14 ]. Moreover, a meta-analysis and another study revealed that AG may be a good choice to assess the prognosis of critically ill patients especially for those in areas with inadequate medical resources [ 15 , 28 ]. Similarly, our data suggested that AG was associated with inhospital all-cause mortality of CCU patients independently, and maybe the adverse effects of increased AG on coronary artery disease and critically ill patients contribute to this result.…”

Section: Discussionmentioning

confidence: 99%

Anion Gap Was Associated with Inhospital Mortality and Adverse Clinical Outcomes of Coronary Care Unit Patients

Sun

Cai

Shen

et al. 2020

BioMed Research International

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Background. Anion gap (AG) has been proved to be associated with prognosis of many cardiovascular diseases. This study is aimed at exploring the association of AG with inhospital all-cause mortality and adverse clinical outcomes in coronary care unit (CCU) patients. Method. All data of this study was extracted from Medical Information Mart for Intensive Care III (MIMIC-III, version 1.4) database. All patients were divided into four groups according to AG quartiles. Primary outcome was inhospital all-cause mortality. Lowess smoothing curve was drawn to describe the overall trend of inhospital mortality. Binary logistic regression analysis was performed to determine the independent effect of AG on inhospital mortality. Result. A total of 3593 patients were enrolled in this study. In unadjusted model, as AG quartiles increased, inhospital mortality increased significantly, OR increased stepwise from quartile 2 (OR, 95% CI: 1.01, 0.74-1.38, P=0.958) to quartile 4 (OR, 95% CI: 2.72, 2.08-3.55, P<0.001). After adjusting for possible confounding variables, this association was attenuated, but still remained statistically significant (quartile 1 vs. quartile 4: OR, 95% CI: 1.02, 0.72-1.45 vs. 1.49, 1.07-2.09, P=0.019). Moreover, CCU mortality (P<0.001) and rate of acute kidney injury (P<0.001) were proved to be higher in the highest AG quartiles. Length of CCU (P<0.001) and hospital stay (P<0.001) prolonged significantly in higher AG quartiles. Maximum sequential organ failure assessment score (SOFA) (P<0.001) and simplified acute physiology score II (SAPSII) (P<0.001) increased significantly as AG quartiles increased. Moderate predictive ability of AG on inhospital (AUC: 0.6291), CCU mortality (AUC: 0.6355), and acute kidney injury (AUC: 0.6096) was confirmed. The interactions were proved to be significant in hypercholesterolemia, congestive heart failure, chronic lung disease, respiratory failure, oral anticoagulants, Beta-blocks, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), and vasopressin treatment subgroups. Conclusion. AG was an independent risk factor of inhospital all-cause mortality and was associated with adverse clinical outcomes in CCU patients.

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Section: Discussionmentioning

confidence: 99%

Anion Gap Was Associated with Inhospital Mortality and Adverse Clinical Outcomes of Coronary Care Unit Patients

Sun

Cai

Shen

et al. 2020

BioMed Research International

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“…These patients were found to have mixed acid-base disorders due to hyperchloremia and hypoalbuminemia, in spite of normal blood gas parameters [182]. Zheng and colleagues [183] studied 78 patients with metabolic acidosis with or without acute kidney injury (AKI). They analyzed physicochemical parameters at 24 and 72 h, at 1 week, 1 month, and 3 months on survival after AKI.…”

Section: Quantitative Acid-base Analysis: the Strong Ion Gapmentioning

confidence: 99%

Acid–Base Balance in the Poisoned Patient

Borron¹

2016

Critical Care Toxicology

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“…While AG predicts short-term mortality, strong ion gap predicts both short- and long-term mortality, in AKI patients with metabolic acidosis. [ 31 ] However, apart from lactate, there is no consensus about the clinical relevance of individual components of metabolic acidosis.…”

Section: Discussionmentioning

confidence: 99%

Early pH change predicts intensive care unit mortality

Samanta

Singh

Baronia

et al. 2018

Indian Journal of Critical Care Medicine

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Aim of the Study:Metabolic acidosis is associated with increased mortality in critically ill patients. We hypothesized that early correction of acidosis of presumed metabolic origin results in improved outcomes.Patients and Methods:We conducted a prospective, observational study from February 2015 to June 2016 in a 12 bed mixed intensive care unit (ICU) of a 1000 bed tertiary care hospital in the north of India. ICU patients aged above 18 years with an admission pH ≥7.0 to <7.35 of presumed metabolic origin were included. Arterial blood gas parameters including pH, PaO2, PaCO2, HCO3−, Na+, K+, Cl−, anion gap (AG), base excess, and lactate at 0, 6, and 24 h along with other standard laboratory investigations were recorded. The primary outcome was to assess the impact of early pH changes on mortality at day 28 of ICU.Results:A total of 104 patients with 60.6% males and 91.3% medical patients were included in the study. Sepsis of lung origin (60.6%) was the predominant etiology. By day 28, 68 (65.4%) patients had died. Median age was 49.5 years, weight 61.7 kg, Sequential Organ Failure Assessment, and Acute Physiologic and Chronic Health Evaluation II scores were 16 and 12, respectively. Nonsurvivors had a higher vasopressor index (P < 0.01), lactate and central venous oxygen saturation (P < 0.05), and lower pH (P < 0.05). A pH correction/change of ≥1.16% during the first 24 h had the best receiver operating characteristic for predicting survival at day 28, with area under the curve (95% confidence interval, 0.72 [0.62–0.82], P < 0.05) compared to HCO3-, BE, lactate, and AG.Conclusions:Metabolic acidosis is associated with higher mortality in ICU. The rate of change in pH may better predict ICU mortality than other metabolic indices.

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Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury

Cited by 25 publications

References 24 publications

Anion Gap Was Associated with Inhospital Mortality and Adverse Clinical Outcomes of Coronary Care Unit Patients

Anion Gap Was Associated with Inhospital Mortality and Adverse Clinical Outcomes of Coronary Care Unit Patients

Acid–Base Balance in the Poisoned Patient

Early pH change predicts intensive care unit mortality

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