Strong ion gap and anion gap corrected for albumin and lactate in patients with sepsis in the intensive care unit.

Emmanouil Alevrakis, Dimitrios-Dorotheos Papadakis, Dimitrios Vagionas, Antonia Koutsoukou, Konstantinos Pontikis, Nikoletta Rovina, Ioannis Vasileiadis
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Abstract

Introduction: Metabolic acidosis is very common amongst critically ill sepsis patients partly due to the presence of unmeasured ions in serum. These ions can be detected by anion gap (AG) or strong ion gap (SIG) concentration values. The purpose of this study is to assess the correlation and potential agreement of the two methods in critically ill patients with sepsis.

Materials and methods: The present is a retrospective study including septic patients admitted to the Intensive Care Unit from December 2014 to July 2016. The [SIG] and the [AG] corrected for albumin and lactate ([AGcl]) were calculated on admission and on sepsis remission or deterioration. The correlation of the two parameters was assessed in all patient groups using the Pearson correlation coefficient and linear regression analysis and the agreement with Bland-Altman plots. ROC survival curves were also generated for the patients in relation to the values of [AGcl], [SIG] and inorganic [SIG] ([SIGi]) on admission.

Results: There was a strong correlation linking [AGcl] and [SIG] values (r>0.9, P<0.05) in all patient groups. The results from all three linear regression equations were statistically significant as the models predicted the [AGcl] value from the [SIG] value with high accuracy. The mean difference of the two methods (i.e. [AGcl] - [SIG] in every patient separately) in septic patients on admission was 11.75 mEq/l with 95% limits of agreement [9.7-13.8]; in patients with sepsis deterioration, it was 11.8 mEq/l with 95% limits of agreement [9.8-13.7] and in patients with sepsis remission, it was 11.5 mEq/l with 95% limits of agreement [10.4-12.7]. ROC survival curves demonstrated a small area under the curve (AUC): [SIG] AUC: 0.479, 95% CI [0.351, 0.606], [SIGi] AUC: 0.581, 95% CI [0.457, 0.705], [AGcl] AUC: 0.529, 95% CI [0.401, 0.656].

Conclusion: [AGcl] and [SIG] demonstrate excellent correlation in septic patients, with a mean difference of about 12 mEq/l. Both parameters failed to demonstrate any predictive ability regarding patient mortality.

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重症监护室脓毒症患者的强离子间隙和阴离子间隙(根据白蛋白和乳酸盐校正)。
简介代谢性酸中毒在脓毒症重症患者中非常常见,部分原因是血清中存在无法测量的离子。这些离子可通过阴离子间隙(AG)或强离子间隙(SIG)浓度值检测到。本研究的目的是评估这两种方法在败血症重症患者中的相关性和潜在一致性:本研究是一项回顾性研究,包括 2014 年 12 月至 2016 年 7 月期间重症监护室收治的脓毒症患者。在入院时以及脓毒症缓解或恶化时计算[SIG]和经白蛋白和乳酸盐校正的[AG]([AGcl])。使用皮尔逊相关系数和线性回归分析评估了所有患者组中这两个参数的相关性,并使用布兰德-阿尔特曼图评估了两者的一致性。还根据患者入院时的[AGcl]、[SIG]和无机[SIG]([SIGi])值绘制了ROC生存曲线:结果:[AGcl]和[SIG]值之间存在很强的相关性(r>0.9,Pcl]值与[SIG]值之间的相关性准确度很高。脓毒症患者入院时两种方法的平均差异(即每位患者的[AGcl]-[SIG])为 11.75 mEq/l,95% 的吻合度为[9.7-13.8];脓毒症恶化患者的平均差异为 11.8 mEq/l,95% 的吻合度为[9.8-13.7];脓毒症缓解患者的平均差异为 11.5 mEq/l,95% 的吻合度为[10.4-12.7]。ROC 生存曲线显示曲线下面积(AUC)较小:[SIG] AUC:0.479,95% CI [0.351,0.606],[SIGi] AUC:0.581,95% CI [0.457,0.705],[AGcl] AUC:0.529,95% CI [0.401,0.656]:结论:[AGcl]和[SIG]在脓毒症患者中显示出极好的相关性,平均差异约为 12 mEq/l。这两个参数都无法预测患者的死亡率。
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