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Association Between Anion Gap and Mortality in Critically Ill Patients with Cardiogenic Shock

Tingting Zhang1, Jie Wang2, Xiangyang Li1

  • 1Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People's Republic of China.

International Journal of General Medicine
|September 1, 2021
PubMed

Insights

Higher anion gap (AG) is linked to increased mortality in critically ill patients with cardiogenic shock (CS). This J-shaped relationship indicates elevated risk across 30, 90, and 365 days, underscoring AG

Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Clinical Chemistry

Background:

  • The association between anion gap (AG) and mortality in critically ill patients with cardiogenic shock (CS) remains understudied.
  • Existing epidemiological data lacks clarity on the specific relationship between AG levels and all-cause mortality in this vulnerable patient population.

Purpose of the Study:

  • To investigate the epidemiological association between the anion gap (AG) and all-cause mortality in critically ill patients experiencing cardiogenic shock (CS).
  • To elucidate the nature of the relationship, specifically identifying if it is linear or nonlinear, and its impact on short-term and long-term survival.

Main Methods:

  • Utilized data from the MIMIC-III V1.4 database, including 1248 intensive care unit patients with cardiogenic shock.
  • Employed a generalized additive model to determine the nonlinear relationship between AG and 30-day mortality.
  • Applied Cox proportional hazard models to assess the association between AG and 30-day, 90-day, and 365-day mortality.

Main Results:

  • A J-shaped nonlinear relationship was observed between the anion gap (AG) and 30-day all-cause mortality.
  • Elevated AG levels were significantly associated with increased risks of 30-day, 90-day, and 365-day mortality in patients with CS, even after adjusting for numerous confounders.
  • Hazard ratios for increased mortality were 1.62 (95% CI, 1.14-2.30) for 30-day, 1.35 (95% CI, 1.04-1.84) for 90-day, and 1.38 (95% CI, 1.03-1.84) for 365-day mortality.

Conclusions:

  • The relationship between anion gap (AG) and 30-day mortality in critically ill patients with cardiogenic shock (CS) is characterized by a J-shaped curve.
  • Higher anion gap (AG) levels are independently associated with a significantly increased risk of all-cause mortality at 30, 90, and 365 days post-intensive care unit admission.
Abstract

Keywords:
Cox proportional hazard regressionMIMIC-IIIanion gapcardiogenic shockcohort studymortality

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