Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study
Abstract Backgrounds High level of anion gap (AG) was associated with organic acidosis. This study aimed to explore the relationship between delta AG (ΔAG = AGmax − AGmin) during first 3 days after intensive care unit (ICU) admission and hospital mortality for patients admitted in the cardiothoracic...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-022-01625-9 |
| _version_ | 1811235527633928192 |
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| author | Kai Xie Chao Zheng Gao-Ming Wang Yi-Fei Diao Chao Luo Ellen Wang Li-Wen Hu Zhi-Jian Ren Jing Luo Bin-Hui Ren Yi Shen |
| author_facet | Kai Xie Chao Zheng Gao-Ming Wang Yi-Fei Diao Chao Luo Ellen Wang Li-Wen Hu Zhi-Jian Ren Jing Luo Bin-Hui Ren Yi Shen |
| author_sort | Kai Xie |
| collection | DOAJ |
| description | Abstract Backgrounds High level of anion gap (AG) was associated with organic acidosis. This study aimed to explore the relationship between delta AG (ΔAG = AGmax − AGmin) during first 3 days after intensive care unit (ICU) admission and hospital mortality for patients admitted in the cardiothoracic surgery recovery unit (CSRU). Methods In this retrospective cohort study, we identified patients from the open access database called Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III). A logistic regression model was established to predict hospital mortality by adjusting confounding factors using a stepwise backward elimination method. We conducted receiver operating characteristic (ROC) curves to compare the diagnostic performance of acid–base variables. Cox regression model and Kaplan Meier curve were applied to predict patients’ 90-day overall survival (OS). Results A total of 2,860 patients were identified. ΔAG was an independent predictive factor of hospital mortality (OR = 1.24 per 1 mEq/L increase, 95% CI: 1.11–1.39, p < 0.001). The area under curve (AUC) values of ΔAG suggested a good diagnostic accuracy (AUC = 0.769). We established the following formula to estimate patients’ hospital mortality: Logit(P) = − 15.69 + 0.21ΔAG + 0.13age-0.21BE + 2.69AKF. After calculating Youden index, patients with ΔAG ≥ 7 was considered at high risk (OR = 4.23, 95% CI: 1.22–14.63, p = 0.023). Kaplan Meier curve demonstrated that patients with ΔAG ≥ 7 had a poorer 90-day OS (Adjusted HR = 3.20, 95% CI: 1.81–5.65, p < 0.001). Conclusion ΔAG is a prognostic factor of hospital mortality and 90-day OS. More prospective studies are needed to verify and update our findings. |
| first_indexed | 2024-04-12T11:52:29Z |
| format | Article |
| id | doaj.art-535fa9fff55042169e51aa3a623da1aa |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-12T11:52:29Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-535fa9fff55042169e51aa3a623da1aa2022-12-22T03:34:07ZengBMCBMC Surgery1471-24822022-05-0122111110.1186/s12893-022-01625-9Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort studyKai Xie0Chao Zheng1Gao-Ming Wang2Yi-Fei Diao3Chao Luo4Ellen Wang5Li-Wen Hu6Zhi-Jian Ren7Jing Luo8Bin-Hui Ren9Yi Shen10Department of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Nanjing Medical UniversityDepartment of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast UniversityDepartment of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical CollegeDepartment of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing UniversityDepartment of Cardiothoracic Surgery, Jinling Hospital, Southern Medical UniversityMcMaster UniversityDepartment of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing UniversityJiangsu Key Laboratory of Molecular and Translational Cancer Research, Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical UniversityDepartment of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing UniversityJiangsu Key Laboratory of Molecular and Translational Cancer Research, Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical UniversityDepartment of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Nanjing Medical UniversityAbstract Backgrounds High level of anion gap (AG) was associated with organic acidosis. This study aimed to explore the relationship between delta AG (ΔAG = AGmax − AGmin) during first 3 days after intensive care unit (ICU) admission and hospital mortality for patients admitted in the cardiothoracic surgery recovery unit (CSRU). Methods In this retrospective cohort study, we identified patients from the open access database called Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III). A logistic regression model was established to predict hospital mortality by adjusting confounding factors using a stepwise backward elimination method. We conducted receiver operating characteristic (ROC) curves to compare the diagnostic performance of acid–base variables. Cox regression model and Kaplan Meier curve were applied to predict patients’ 90-day overall survival (OS). Results A total of 2,860 patients were identified. ΔAG was an independent predictive factor of hospital mortality (OR = 1.24 per 1 mEq/L increase, 95% CI: 1.11–1.39, p < 0.001). The area under curve (AUC) values of ΔAG suggested a good diagnostic accuracy (AUC = 0.769). We established the following formula to estimate patients’ hospital mortality: Logit(P) = − 15.69 + 0.21ΔAG + 0.13age-0.21BE + 2.69AKF. After calculating Youden index, patients with ΔAG ≥ 7 was considered at high risk (OR = 4.23, 95% CI: 1.22–14.63, p = 0.023). Kaplan Meier curve demonstrated that patients with ΔAG ≥ 7 had a poorer 90-day OS (Adjusted HR = 3.20, 95% CI: 1.81–5.65, p < 0.001). Conclusion ΔAG is a prognostic factor of hospital mortality and 90-day OS. More prospective studies are needed to verify and update our findings.https://doi.org/10.1186/s12893-022-01625-9Anion gapCardiothoracic surgeryMortalityAcid-basic disturbancesMIMIC III |
| spellingShingle | Kai Xie Chao Zheng Gao-Ming Wang Yi-Fei Diao Chao Luo Ellen Wang Li-Wen Hu Zhi-Jian Ren Jing Luo Bin-Hui Ren Yi Shen Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study BMC Surgery Anion gap Cardiothoracic surgery Mortality Acid-basic disturbances MIMIC III |
| title | Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study |
| title_full | Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study |
| title_fullStr | Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study |
| title_full_unstemmed | Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study |
| title_short | Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study |
| title_sort | association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit a retrospective cohort study |
| topic | Anion gap Cardiothoracic surgery Mortality Acid-basic disturbances MIMIC III |
| url | https://doi.org/10.1186/s12893-022-01625-9 |
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