Unmeasured anions and mortality in the critically ill: The chicken or the egg? *

Çuhaci, Bülent

doi:10.1097/01.ccm.0000080494.04523.da

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…The sex distribution of this study was -male 63.5 % (146/230) and females were 36.5% (84/230). The male predominance so far in admission agrees with other studies like Kapil and Bagga (73%), [16] Hossain et al [17] The main reasons for NICU admission were perinatal asphyxia with complications (24.8%), problems related to preterm low birth weight (20.4 %) and major congenital anomalies (23%) in this study. It was observed that 55.2% of the critically ill newborns treated in the NICU had acid-base derangements and had higher mortality than those without acid-base imbalances.…”

Section: Discussionsupporting

confidence: 92%

Frequency of Acid-Base Derangements Among the Neonates Admitted to the Intensive Care Unit

Hosain,

Mohsin,

Hussain

et al. 2023

AIMDR

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Background: Every year deranged acid-base physiology drives admission to a critical care arena for a vast number of neonates. The neonatal intensive care unit is a fundamental sector for the survival of high-risk newborns. The acid-base disorder must always be considered in the clinical setting. The clinician should, in most cases, be able to predict the type of acid-base imbalance before the blood gas is available. Arterial blood gases (ABG-s) are the gold standard for assessing the adequacy of oxygen delivery, ventilation, and pH. This study aimed to assess the frequency of acid-base derangements among neonates admitted to the intensive care unit. Material & Methods: This was an observational cohort study that was conducted in the Neonatal Intensive Care Unit (I.C.U.) of Dhaka Shishu Hospital, Dhaka, Bangladesh during the period from October 2009 to September 2010. In total 230 neonates admitted to the Neonatal Intensive Care Unit, after fulfilling the inclusion criteria were enrolled in this study as study subjects. For each baby, a detailed history was recorded in a questionnaire form (enclosed herewith) from the mother or other caregiver. It was filled up by the researcher himself containing history (including antenatal history), physical examinations and laboratory findings. Arterial blood gas analysis was done (in a clinical biochemistry laboratory using an automatic analyzer machine) for each neonate at admission and that report was recorded for this study. Results: Among the total study subjects, 127 newborn babies (55.2%) had acid-base imbalances. Mixed acidosis prevailed in the highest frequency (23.9%) Then metabolic acidosis cases were at 17.8% and respiratory acidosis was at 13.9%. Metabolic alkalosis and respiratory alkalosis were absent. Normal blood gas was observed in 44.3% of newborns. All the neonates with pH <7 were dead. After Chi-Square analysis (at df=1), we found a highly significant correlation between mortality outcome with pH <7.35, CO2 >45, HCO3 < 22 mol/l and Base deficit >-10. All modalities of acid-base imbalances were significantly associated with mortality. Conclusion: In this study, a significant number of neonates who were admitted to the intensive care unit, can develop acid-base derangement. Mixed acidosis was found in the highest frequency. Metabolic, respiratory and mixed acidosis all has a significant correlation with death in a NICU. Metabolic alkalosis and respiratory alkalosis were found absent at admission.

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Section: Discussionsupporting

confidence: 92%

Frequency of Acid-Base Derangements Among the Neonates Admitted to the Intensive Care Unit

Hosain,

Mohsin,

Hussain

et al. 2023

AIMDR

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“…No matter how they are calculated, acid–base variables are not reliable indicators of hospital mortality in critically ill patients 21 . In contrast, the study by Cuhaci B claims that, after careful computation, the serum cation gap is a reliable indicator of hospital mortality in critically ill patients 22 . Patient survival at 28 days was tracked by Cusack RJ et al 23 They discovered a significant difference in the mean AG of survivors and non‐survivors ( p = 0.007).…”

Section: Discussionmentioning

confidence: 98%

“…21 In contrast, the study by Cuhaci B claims that, after careful computation, the serum cation gap is a reliable indicator of hospital mortality in critically ill patients. 22 Patient survival at 28 days was tracked by Cusack RJ et al 23 They discovered a significant difference in the mean AG of survivors and non-survivors (p = 0.007). The mean SIG did not significantly differ between survivors and nonsurvivors (p = 0.088).…”

Section: Discussionmentioning

confidence: 99%

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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“…Actually, the result is not unexpected since two previous studies reached similar conclusion [ 4 , 5 ]. These results probably support the comment provided by Cuhaci in the accompanying editorial stating “It is probably fair to say that the likelihood of any prospective study to reveal additional important information on the association between any of these acid-base variables and the outcome seems to be remote.” [ 6 ]. However, I would like to comment on several issues about this topic.…”

Section: Main Bodymentioning

confidence: 99%

“…By correcting AG with albumin, the difference between ACAG and SIG is theoretically the contribution of Ca, Mg, phosphate, and bicarbonate. Actually, the bias between ACAG and SIG is smaller than the bias between the original AG and SIG [ 10 ], and these two parameters probably significantly correlate as Cuhaci commented [ 6 ]. Collectively, it is also quite reasonable that ACAG and SIG have similar prognostic ability about mortality found in these studies.…”

Section: Main Bodymentioning

confidence: 99%

Unmeasured anions and mortality in critically ill patients in 2016

Kotake¹

2016

j intensive care

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The presence of acid-base disturbances, especially metabolic acidosis may negatively affect the outcome of critically ill patients. Lactic acidosis is the most frequent etiology and has largest impact on the prognosis. Since lactate measurement might not have always been available at bedside, it had been regarded as one of the unmeasured anions. Therefore, anion gap and strong ion gap has been used to as a surrogate of lactate concentration. From this perspective, the relationship between either anion gap or strong ion gap and mortality has been explored. Then, lactate became routinely measurable at bedside and the direct comparison between directly measured lactate and these surrogate parameters can be possible. Currently available evidence suggests that directly measured lactate has larger prognostic ability for mortality than albumin-corrected anion gap and strong ion gap without lactate. In this commentary, the rationale and possible clinical implications of these findings are discussed.

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Unmeasured anions and mortality in the critically ill: The chicken or the egg? *

Cited by 6 publications

References 19 publications

Frequency of Acid-Base Derangements Among the Neonates Admitted to the Intensive Care Unit

Frequency of Acid-Base Derangements Among the Neonates Admitted to the Intensive Care Unit

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

Unmeasured anions and mortality in critically ill patients in 2016

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