Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 28;14(1):31275.
doi: 10.1038/s41598-024-82700-4.

Association between anion gap/calcium ratio and 30-day all-cause mortality in sepsis patients with diabetes mellitus

Jing Cai #  1 , Lin Pu #  2 , Nanbing Yuan  2 , Meng Liu  3 , Ken Lin  2 , Jie Gao  2 , Jingjing Li  2
Affiliations

Association between anion gap/calcium ratio and 30-day all-cause mortality in sepsis patients with diabetes mellitus

Jing Cai et al. Sci Rep. .

Abstract

We aimed to determine the association between anion gap-to-calcium ratio (ACR) and 30-day mortality in sepsis patients with diabetes mellitus (DM). Data for sepsis patients diagnosed with DM was extracted from Medical Information Mart for Intensive Care Database IV. After screening, 4429 eligible subjects were included in our study finally. The receiver operating characteristic (ROC) curve was used to determine the cut-off value. According to the ROC curve analysis, the ACR demonstrated a higher area under the curve (AUC) of 0.622 compared to AG (0.598). Multivariable logistic regression with inverse probability of treatment weighting (IPTW) based on propensity score were used to detect the association between ACR and 30-day mortality. Our results showed that the patients with the high level of ACR had a higher risk of death within 30 days compared with those with low level of ACR (odds ratio 1.342, 95% confidence interval 1.180-1.526, P < 0.001). In a word, our results suggest that ACR may be an independent prognostic indicator for death with 30 days in critically ill patients with sepsis and DM.

Keywords: Anion gap; Calcium; Diabetes mellitus (DM); Mortality; Sepsis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection. Abbreviations: MIMIC-IV 3.0, Medical Information Mart for Intensive Care IV, Version: 3.0; ICU, intensive care unit; DM, diabetes mellitus. ACR, anion gap-to-calcium ratio; PSM, propensity score matching.
Fig. 2
Fig. 2
ROC curve of ACR, SOFA, AG and Ca for predicting the all-cause mortality in the overall study population. The optimal cut-off value of ACR for the 30-day all-cause mortality was 1.89, with a sensitivity of 0.501 and a specificity of 0.704. Abbreviations: ROC, receiver operating characteristic; ACR, anion gap-to-calcium ratio; AUC, area under curve; AG, anion gap; Ca, calcium; SOFA, Sequential Organ Failure Assessment.
Fig. 3
Fig. 3
Kaplan–Meier survival curves of septic patients with DM at 30-day, with high (green, ACR ≥ 1.89) and low (red, ACR < 1.89) ACR. (A and B) were reflected the results before and after propensity score matching, respectively. Abbreviations: DM, diabetes mellitus; ACR, anion gap-to-calcium ratio.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet402(10397), 203–234. 10.1016/S0140-6736(23)01301-6 (2023). - PMC - PubMed
    1. Schertzer, J. D. & Steinberg, G. R. Immunometabolism: The interface of immune and metabolic responses in disease. Innunol. Cell. Biol.92(4), 303. 10.1038/icb.2014.12 (2014). - PubMed
    1. Donath, M. Y. & Shoelson, S. E. Type 2 diabetes as an inflammatory disease. Nat. Rev. Immunol.11(2), 98–107. 10.1038/nri2925 (2011). - PubMed
    1. Devaraj, S., Venugopal, S. K., Singh, U. & Jialal, I. Hyperglycemia induces monocytic release of interleukin-6 via induction of protein kinase c-{alpha} and -{beta}. Diabetes54(1), 85–91. 10.2337/diabetes.54.1.85 (2005). - PubMed
    1. Berbudi, A., Rahmadika, N., Tjahjadi, A. I. & Ruslami, R. Type 2 diabetes and its impact on the immune system. Curr. Diabetes Rev.16(5), 442–449. 10.2174/1573399815666191024085838 (2020). - PMC - PubMed