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. 2023 Nov;55(11):2967-2980.
doi: 10.1007/s11255-023-03583-4. Epub 2023 Apr 7.

Associations of continuous anionic gap detection with the mortality in critically ill patients receiving renal replacement therapy

Yiling Zhai #  1   2 , Changjun Luo #  3   4 , Tao Zhou  5   4 , Guangzhi Zeng  6 , Qiongyan Huang  7 , Jun Li  3
Affiliations

Associations of continuous anionic gap detection with the mortality in critically ill patients receiving renal replacement therapy

Yiling Zhai et al. Int Urol Nephrol. 2023 Nov.

Abstract

Purpose: To investigate the associations of anion gap (AG) levels before and 1-day after hemodialysis as well as anion gap changes with the mortality in critically ill patients receiving renal replacement therapy (RRT).

Methods: Totally, 637 patients from MIMIC-III were included in this cohort study. The associations between AG (T0), AG (T1), or ∆AG [AG (T0) - AG (T1)], and the risk of 30-day or 1-year mortality were examined by Cox restricted cubic spline regression models. Univariate and multivariate Cox proportional-hazards model was applied to assess the associations between AG (T0), AG (T1), ∆AG with 30-day and 1-year mortality, respectively.

Results: The median follow-up time was 18.60 (8.53, 38.16) days and 263 (41.3%) patients were survived. There was a linear relationship between AG (T0), AG (T1) or ∆AG and the risk of 30-day or 1-year mortality, respectively. The risk of 30-day mortality was higher in AG (T0) > 21 group (HR = 1.723, 95% CI 1.263-2.350), and AG (T1) > 22.3 group (HR = 2.011, 95% CI 1.417-2.853), while lower in AG > 0 group (HR = 0.664, 95% CI 0.486-0.907). The risk of 1-year mortality was increased in AG (T0) > 21 group (HR = 1.666, 95% CI 1.310-2.119), and AG (T1) > 22.3 group (HR = 1.546, 95% CI 1.159-2.064), while decreased in AG > 0 group (HR = 0.765, 95% CI 0.596-0.981). Patients with AG (T0) ≤ 21 had higher 30-day and 1-year survival probability than those with AG (T0) > 21.

Conclusion: AG before and after dialysis as well as the changes of AG were important factors associated with the risk of 30-day and 1-year mortality in critically ill patients receiving RRT.

Keywords: Dialysis; Renal replacement therapy; Serum anion gap; ∆AG.

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Conflict of interest statement

The authors have declared that no conflict of interest exists.

Figures

Fig. 1
Fig. 1
The screen process of the participants
Fig. 2
Fig. 2
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T0) and the risk of 30-day mortality in the patients
Fig. 3
Fig. 3
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T0) and the risk of 1-year mortality in the patients
Fig. 4
Fig. 4
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T1) and the risk of 30-day mortality in the patients
Fig. 5
Fig. 5
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T1) and the risk of 1-year mortality in the patients
Fig. 6
Fig. 6
The Cox regression model with a restricted cubic spline showing a linear relationship between ∆AG and the risk of 30-day mortality in the patients
Fig. 7
Fig. 7
The Cox regression model with a restricted cubic spline showing a linear relationship between ∆AG and the risk of 1-year mortality in the patients
See this image and copyright information in PMC

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