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Sheng H, Lu J, Zhong L, Hu B, Sun X, Dong H. The correlation between albumin-corrected anion gap and prognosis in patients with acute myocardial infarction. ESC Heart Fail 2024; 11:826-836. [PMID: 38164072 DOI: 10.1002/ehf2.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Acute 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 RESULTS Data 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. CONCLUSIONS Elevated 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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Affiliation(s)
- Haiying Sheng
- Department of Digital Subtraction Angiography, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Jianhong Lu
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Beiping Hu
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Xu Sun
- Department of General Surgery, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Huifeng Dong
- Department of Intensive Care Unit, Huzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou University, Huzhou, China
- Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
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Hagiwara S, Murata M, Kaneko M, Aoki M, Kanbe M, Ohyama Y, Tamura J, Oshima K. Usefulness of serum fibrin degradation products and D-dimer levels as biomarkers to predict return of spontaneous circulation in patients with cardiopulmonary arrest on arrival: comparison with acid-base balance. Acute Med Surg 2014; 1:222-227. [PMID: 29930852 DOI: 10.1002/ams2.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/06/2014] [Indexed: 11/09/2022] Open
Abstract
Aim We evaluated the usefulness of fibrin degradation products and D-dimer levels in blood to predict return of spontaneous circulation in patients with cardiopulmonary arrest on arrival compared with anion gap and albumin-corrected anion gap. Methods We retrospectively reviewed the medical records of patients with cardiopulmonary arrest on arrival who had been transferred to the emergency department of our hospital in 2012. Patients were divided into two groups: patients with return of spontaneous circulation (ROSC(+) group), and those without (ROSC(-) group). The levels of anion gap, albumin-corrected anion gap, fibrin degradation products and D-dimer measured on arrival were compared between the two groups. Results Fifty-three patients could be analyzed. The anion gap and albumin-corrected anion gap levels were significantly better in the ROSC(+) group than in the ROSC(-) group (anion gap, 28.7 mmol/L [median] versus 39.1 mmol/L; albumin-corrected anion gap, 31.1 mmol/L versus 40.9 mmol/L). The fibrin degradation product and D-dimer levels were significantly lower in the ROSC(+) group than in the ROSC(-) group (fibrin degradation products, 32.1 μg/mL versus 157.4 μg/mL; D-dimer, 9.9 μg/mL versus 37.4 μg/mL). The area under receiver operating characteristic curves to evaluate the relationship with return of spontaneous circulation of anion gap, albumin-corrected anion gap, fibrin degradation products, and D-dimer were 0.664, 0.667, 0.714, and 0.707, respectively. Conclusion Fibrin degradation products and D-dimer levels might be more useful as predictors of return of spontaneous circulation than anion gap and albumin-corrected anion gap.
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Affiliation(s)
- Shuichi Hagiwara
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Masato Murata
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Minoru Kaneko
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Makoto Aoki
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Masahiko Kanbe
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan
| | - Yoshio Ohyama
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan.,Department of General Medicine Gunma University Graduate School of Medicine Maebashi Japan
| | - Jun'ichi Tamura
- Emergency and General Medical Center Gunma University Hospital Maebashi Japan.,Department of General Medicine Gunma University Graduate School of Medicine Maebashi Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Japan.,Emergency and General Medical Center Gunma University Hospital Maebashi Japan
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