Serum Anion Gap Predicts All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury: Analysis of the MIMIC-III Database

Cheng, Bihuan; Li, Diwen; Gong, Yuqiang; Ying, Binyu; Wang, Benji

doi:10.1155/2020/6501272

Cited by 43 publications

(45 citation statements)

References 31 publications

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“…Moreover, critically ill patients are always exposed to hypoxia and anaerobic tissue, which results in the rapid accumulation of pyruvate, and pyruvate may be converted into lactate in some circumstances [ 27 ]. However, patients with AKI always suffer from lactate dehydrogenase dysfunction, and they are not able to clear endogenous acid production, which causes high levels of LDH [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

Zhang

Shi

2021

Int Urol Nephrol

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Objective Sixty percent of critically ill patients suffer from acute kidney injury (AKI) and 12% of them require renal replacement therapy during their ICU stay. However, we lack effective biomarkers to predict the mortality of critically ill patients with AKI. Few studies have investigated the association between lactate dehydrogenase levels and mortality in patients with AKI. Methods We conducted a retrospective cohort study with large samples, using a large database, the Multi parameter Intelligent Monitoring in Intensive Care III project. Clinical and demographic data were collected from the database by structure query language. Multiple models were constructed by stepwise methods to examine the association between lactate dehydrogenase (LDH) and in-hospital mortality. The predictive performance of LDH was assessed by ROC analysis and p values were calculated for trends. Results In the final analysis, 8436 patients met the inclusion criteria, and 1519 patients died during their hospital stay. The mortality rate increased with increasing LDH levels. The association between LDH and in-hospital mortality was almost linear ( p < 0.001). A multiple logistic regression model indicated that LDH level was an independent predictor of in-hospital mortality (OR = 1.56, 95% CI (1.39–1.73), p < 0.001) and this effect remained stable in the subgroup analysis. Moreover, the combined AUC of LDH and SAPSII was 0.83. Conclusions The LDH level, which can be easily assessed, is significantly and independently associated with in-hospital mortality, and could increase the predictive ability of SAPSII for in-hospital mortality in our study.

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Section: Discussionmentioning

confidence: 99%

Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

Zhang

Shi

2021

Int Urol Nephrol

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“…Kim and his team 20 reported that corrected AG in children at ICU admission was associated with mortality, with odds ratio (95% CI) 1.110 (1.06–1.17). Cheng et al, 17 and Tang et al, 21 confirmed a U-shaped relationship between serum AG levels and all-cause mortality in critically ill patients with acute kidney injury and patients with congestive heart failure, respectively. Our findings are consistent with previous studies.…”

Section: Discussionmentioning

confidence: 90%

“…The serum AG has been reported to be associated with death and complications in a variety of diseases. Cheng et al, 17 found that high serum AG values in patients with acute kidney injury had higher all-cause mortality at 30 days, 90 days, and 365 days, HR (95% CI) were: 1.54 (1.33–1.75), 1.55, (1.38–1.73), and 1.46 (1.31–1.60) respectively. Abramowitz et al, 18 found that the serum AG value was associated with mortality, the Relative Hazard (95% CI) was 1.20 (1.03–1.41), and higher levels of serum AG were present in patients with impaired renal function.…”

Section: Discussionmentioning

confidence: 98%

The Relationship Between the Serum Anion Gap and All-Cause Mortality in Acute Pancreatitis: An Analysis of the MIMIC-III Database

Gong

Zhou

Gui

et al. 2021

IJGM

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Purpose We aimed to investigate the relationship between the serum anion gap (AG) and all-cause mortality in patients with acute pancreatitis (AP) in intensive care units (ICUs). Patients and Methods In this retrospective cohort analysis, data of patients with AP were extracted from the Medical Information Mart for Intensive Care database (version III). We collected the maximum serum AG value within the first 24 hours of ICU admission. The main outcome was 90-day all-cause mortality. A multivariate Cox proportional hazard regression model was used to examine the association between the serum AG and mortality. The restricted cubic spline curve was used to confirm a non-linear relationship between serum AG values and mortality. Results Of the 279 patients included in the study, 87 (31.18%) died. The serum AG value was positively associated with 90-day all-cause mortality (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.02–1.14), after adjusting for age, sex, alcohol consumption, congestive heart failure, diabetes mellitus, hypertension, eGFR, albumin, and the SOFA score. There was a non-linear relationship between serum AG values and mortality after adjusting for potential confounders. We used a two-piecewise regression model to obtain a threshold inflection point value of 13.8 mmol/L. The HR and the 95% CI on the left inflection point were 0. 82 (0.61–1.09; p = 0.1719), and on the right inflection point were 1.15 (1.08–1.23; p < 0.0001). Conclusion The relationship between all-cause mortality in patients with acute pancreatitis and serum AG values was non-linear. All-cause mortality and serum AG values were positively correlated when the serum AG value was >13.8 mmol/L.

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“…Code 577.0 of the ICD-9 speci cation was used to identify 961 patients who were admitted to an ICU with AP for the rst time. [15] We excluded patients with no major laboratory test results or ICU admission severity score within the rst 24 hours, and also patients younger than 18 years. Finally, 850 people who met the inclusion criteria were selected.…”

Section: Patients and Inclusion Criteriamentioning

confidence: 99%

A novel nomogram for predicting survival in patients with severe acute pancreatitis: an analysis based on the large MIMIC-III clinical database

Han

et al. 2020

Preprint

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Background Severe acute pancreatitis (SAP) can cause various complications. Septic shock is a relatively common and serious complication that causes uncontrolled systemic inflammatory response syndrome, which is one of the main causes of death. This study aimed to develop a nomogram for predicting the overall survival of SAP patients during the initial 24 hours following admission. Materials and Methods All data utilized in this study were obtained from the MIMIC-III (Medical Information Mart for Intensive Care III) database. The data were analyzed using multivariate Cox regression, and the performance of the proposed nomogram was evaluated based on Harrell’s concordance index (C-index) and the area under the receiver operating characteristic curve(AUC). The clinical value of the prediction model was tested using decision-curve analysis (DCA). The primary outcomes were 28-day,60-day, and 90-day mortality rates. Results The 850 patients included in the analysis comprised 595 in the training cohort and 255 in the validation cohort. The training cohort consisted of 353 (59.3%) males and 242 (40.7%) females with SAP. Multivariate Cox regression showed that weight, sex, insurance status, explicit sepsis, SAPSII score, Elixhauser score, bilirubin, anion gap, creatinine, hematocrit, hemoglobin, RDW, SpO 2 , and respiratory rate were independent prognostic factors for the survival of SAP patients admitted to an intensive care unit. The predicted values were compared using C-indexes, calibration plots, integrated discrimination improvement, net reclassification improvement, and DCA. Conclusions We have identified some important demographic and laboratory parameters related to the prognosis of patients with SAP, and have used them to establish a more accurate and convenient nomogram for evaluating their 28-day, 60-day, and 90-day all-cause mortality rates. The prognostic value of the novel nomogram is superior to that of the traditional SAPSII scoring system alone.

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Serum Anion Gap Predicts All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury: Analysis of the MIMIC-III Database

Cited by 43 publications

References 31 publications

Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

The Relationship Between the Serum Anion Gap and All-Cause Mortality in Acute Pancreatitis: An Analysis of the MIMIC-III Database

A novel nomogram for predicting survival in patients with severe acute pancreatitis: an analysis based on the large MIMIC-III clinical database

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