Prognostic significance of albumin corrected anion gap in patients with acute pancreatitis: a novel perspective

This study aims to explore the relationship between the albumin-corrected anion gap (ACAG) and short- and long-term all-cause mortality (ACM) in patients with acute pancreatitis (AP) managed in the intensive care unit (ICU). We conducted a retrospective analysis utilizing data extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. This study sought to investigate the correlation between ACAG and ACM among patients diagnosed with AP across various disease stages. R statistical software was used to identify the optimal thresholds for ACAG. Kaplan-Meier survival curves and multivariate Cox proportional hazards regression models were employed to assess the association between ACAG and short- and long-term ACM of AP. The predictive ability, sensitivity, specificity, and area under the curve (AUC) of ACAG for short- and long-term ACM in AP were investigated using receiver operating characteristic analysis. Subgroup analyses were also conducted. A cohort comprising 605 participants was included in this study. The ideal threshold for ACAG identified by R statistical software was 21.5. Cox proportional hazards modeling revealed that there was an independent association between patients with AP with ACAG ≥ 21.5 and ACM at 3, 7, 10, 14, 28, 90, and 180 days and 1 year before and after adjustment for confounders. Survival curves demonstrated that patients with ACAG ≥ 21.5 had lower survival rates at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. In addition, ACAG showed superior performance, with a larger AUC than the anion gap, albumin, and Systemic Inflammatory Response Syndrome score and Sequential Organ Failure Assessment at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. Subgroup analysis revealed no significant interaction between ACAG and any subgroups Elevated levels of ACAG were found to be associated with increased short- and long-term ACM in patients with AP, and ACAG may be an independent predictor of ACM at different disease stages.

Independent prognostic importance of the albumin-corrected anion gap in critically ill patients with congestive heart failure: a retrospective study from MIMIC-IV database

BACKGROUND

The associations between the albumin-corrected anion gap (ACAG) and all-cause mortality in patients with congestive heart failure in the intensive care unit remain uncertain. This study aimed to investigate this unknown.

METHODS

The MIMIC-IV (version 3.0) database was used to analyze critically ill patients with congestive heart failure. Patients were grouped into tertiles (T1-T3) on the basis of the ACAG. The association between ACAG levels and 1-year all-cause mortality was assessed using Kaplan-Meier survival analyses, multivariate adjusted Cox regression models, and restricted cubic spline curves. An analysis of subgroups was performed to evaluate ACAG's prognostic impact across diverse populations. Mediation analysis was conducted to identify and elucidate potential causal pathways linking ACAG to all-cause mortality.

RESULTS

A cohort of 7787 patients was analyzed. On the basis of Kaplan-Meier curves, Cox regression, restricted cubic spline curves and subgroup analysis, T2 (hazard ratio 1.09, 95% confidence interval 1.02 ~ 1.16) and T3 (hazard ratio 1.25, 95% confidence interval 1.17 ~ 1.33) individuals presented a greater mortality risk compared to T1 individuals (p for linear trend < 0.001), and most subgroups consistently observed this relationship, except for those with different levels of left ventricular ejection fraction. Mediation analysis indicated that the red cell distribution width, stage of acute kidney injury, chloride and acute physiology score III partially mediated the relationship between ACAG and mortality, accounting for 12.4%, 7.0%, 12.9%, and 31.2% of the mediating effect, respectively.

CONCLUSIONS

The ACAG was associated with higher 1-year all-cause mortality in critically ill patients with congestive heart failure, with stronger impact in those with lower left ventricular ejection fractions. The ACAG may serve as an indicator in high-risk groups.

CLINICAL TRIAL NUMBER

Not applicable.

Increased serum albumin corrected anion gap levels are associated with poor prognosis in septic patients with liver cirrhosis

The prognosis of septic patients with cirrhosis is worse compared to septic patients without cirrhosis. Early and accurate prognosis determination in patients with cirrhosis and sepsis is pivotal for guiding treatment decisions. The aim of this study was to investigate the association between albumin-corrected anion gap (ACAG) and clinical prognosis of patients with sepsis and cirrhosis. This study extracted data of patients with sepsis and cirrhosis from the Medical Information Mart for Intensive Care (MIMIC-IV) database. A total of 1340 patients (64.6% male) were enrolled. After confounders adjusting, elevated ACAG had a significant association with 28-day mortality (HR1.604; 95% CI 1.258-2.048; P < 0.001). Restricted cubic spline revealed that a linear relationship between ACAG and 28-day mortality (P-nonlinear = 0.089, P-overall = 0.001). According to the ROC curve analysis, the ACAG demonstrated a higher area under the curve (AUC) of 0.703 compared to AG (0.675). Kaplan-Meier analysis revealed higher 28-day mortality in high ACAG group (log-rank test, χ^2 = 175.638, P < 0.001). Furthermore, subgroup analysis showed a significant interaction between ACAG and etiology of cirrhosis (P for interaction = 0.014). Therefore, ACAG could provide clinicians with valuable insights for guiding interventions in this high-risk population.

Association between albumin-corrected anion gap level and the risk of acute kidney injury in intensive care unit

PURPOSE

This study was to investigate the association between albumin-corrected anion gap (AG) (ACAG) levels and the risk of acute kidney injury (AKI) in intensive care unit (ICU) patients.

METHODS

The ICU patients of this retrospective cohort study were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. ACAG = AG + {4.4 - [albumin (g/dl)]} × 2.5. The incidence of AKI was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. The logistic regression model was used to evaluate the association between ACAG levels and the risk of AKI. Subgroup analyses were applied based on age, gender, mechanical ventilation, vasopressors, the Charlson comorbidity index (CCI), and the Simplified Acute Physiology Score II (SAPS II).

RESULTS

Totally, 5586 patients were enrolled, of which 1929 patients (34.53%) occurred AKI. The higher levels of ACAG were associated with the risk of AKI in ICU patients, with the odds ratio (OR) value being 1.23 [95% confidence interval (CI): 1.22-1.24, P = 0.005] in ACAG level between 16.5 and 19.5, and OR value being 1.20 (95% CI 1.16-1.24, P = 0.016) in ACAG level > 19.5. A higher ACAG level was associated with a higher risk of AKI in ICU patients aged < 65 years, in ICU patients of female gender, in ICU patients who used mechanical ventilation, in ICU patients who did not use vasopressors, in patients without cardiogenic shock, and in ICU patients with CCI ≥ 2, and SAPS II > 31 (all P < 0.05).

CONCLUSION

There is an association between ACAG level and the risk of AKI in ICU patients. A higher ACAG value in ICU patients should therefore receive more attention.

Association of elevated albumin-corrected anion gap with all-cause mortality risk in atrial fibrillation: a retrospective study

BACKGROUND

Compared to the conventional anion gap, the albumin-corrected anion gap (ACAG) offers a more precise measure of acid-base imbalance, providing superior prognostic insight. However, the prognostic relevance of ACAG in individuals of atrial fibrillation (AF) remains insufficiently explored. This research seeks to evaluate the correlation between ACAG levels and mortality risk in individuals with AF.

METHODS

We identified individuals diagnosed with AF from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Participants were categorized into quartiles based on their ACAG levels. The outcomes included 30 days and 365 days all-cause mortality. Kaplan-Meier survival curves were utilized to evaluate cumulative survival across the ACAG quartiles. We applied Cox regression and restricted cubic spline regression analyses to evaluate the correlation between ACAG levels and prognosis. Subgroup analyses and interaction assessments were applied to confirm the robustness of the findings.

RESULTS

A total of 2920 AF patients (54.93% male) were incorporated into the analysis, with 1.61% identified as having paroxysmal AF. The 30-day and 365-day mortality rates were 22.91% and 39.21%, respectively. Kaplan-Meier survival curves demonstrated that elevated ACAG levels were significantly linked to increased mortality (log-rank P < 0.001). In multivariate Cox proportional hazards analyses, increased ACAG independently predicted mortality at both 30 days (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.02-1.05; P < 0.01) and 365 days (aHR, 1.03; 95% CI, 1.02-1.05; P < 0.01) after adjusting for potential confounders. A positive relationship between rising ACAG levels and mortality risk was showed by restricted cubic spline analysis. Subgroup analyses revealed no significant interactions (all interaction P-values > 0.05).

CONCLUSIONS

In individuals with AF, higher ACAG levels are related to a greater mortality risk at 30 and 365 days. These findings suggest that ACAG may serve as a valuable prognostic marker for AF patient stratification. Incorporating ACAG into clinical decision-making could support improved therapeutic strategies and enhance patient outcomes.

Revisiting Stewart's Approach toward Assessment of Unidentified or Complex Acid-Base Disorders

How to cite this article: Gopaldas JA. Revisiting Stewart's Approach toward Assessment of Unidentified or Complex Acid-Base Disorders. Indian J Crit Care Med 2022;26(1):5-6.

The association of albumin-corrected anion gap and acute kidney injury in heart failure patients: a competing risk model analysis

BACKGROUND

The combination of heart failure (HF) and acute kidney injury (AKI) increases the mortality of patients. It is critical to identify HF patients who may have a high risk for AKI. Albumin-corrected anion gap (ACAG) is a new indicator, but there are no studies on ACAG and the risk of AKI in HF patients.

METHODS

Data for HF patients was obtained from the MIMIC-IV database. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were employed to evaluate the clinical value of ACAG in predicting AKI risk. Logistic regression analysis and restricted cubic spline (RCS) curve were conducted to explore the relationship between ACAG and AKI. A competing risk model was developed to further investigate the relationship between ACAG on AKI.

RESULTS

The study analyzed 5,972 HF patients, with 49.82% (2886/5972) suffering from AKI. The prediction performance of ACAG on AKI was good (AUC:0.656). Continuous ACAG was associated with AKI after adjusting for various significant variables (Model 1: OR = 1.094, 95%CI: 1.078-1.110; Model 2: OR = 1.150, 95%CI: 1.133-1.166; Model 3: OR = 1.035, 95%CI. 1.017-1.054). All High ACAG groups showed a higher risk of AKI (all P < 0.001). ACAG was also linked to in-hospital mortality (P < 0.001). The competing risks model revealed that high ACAG was still a risk factor for AKI when in-hospital mortality served as a competing risk event (P < 0.001).

CONCLUSION

High ACAG was associated with the risk of AKI in HF patients. Clinicians can risk-stratify HF patients by combining ACAG levels.

Association of albumin-corrected anion gap with severe consciousness disorders and outcomes in ischemic stroke: a retrospective MIMIC analysis

The relationship between albumin-corrected anion gap (ACAG) and severe disorder of consciousness (SDOC), in-hospital mortality, and long-term mortality in patients with ischemic stroke (IS) remains unclear. This study investigates the association of ACAG with SDOC and other outcomes in IS using data from the MIMIC-IV database. A total of 2,379 IS patients were included, with a demographic breakdown showing 51% were male and an SDOC incidence of 16.4%. Analysis through Cox proportional hazards models indicated that ACAG is significantly associated with the risks of both SDOC and mortality. Additionally, restricted cubic spline(RCS) analysis suggested a nearly linear relationship between increasing ACAG levels and the incidence of SDOC. Kaplan-Meier curves demonstrated significant differences in the incidence rates of SDOC, in-hospital mortality, and long-term mortality across varying ACAG levels. The findings suggest that ACAG serves as an independent predictor for SDOC, in-hospital mortality, and long-term mortality in IS patients. Nonetheless, further prospective studies are needed to confirm these causal relationships.