| Objective To explore the prognosis of serum anion gap(AG)in patients with sepsis and evaluate its clinical efficacy,and it is expected to improve the clinician’s ability to assess the prognosis of patients with sepsis.Methods After registering and completing relevant ethics courses,the permission of the Medical Information Mart for Intensive Care(MIMIC-Ⅲ)was obtained,and all relevant data of patients that meet the sepsis 3.0 diagnostic criteria was extracted by structured query language(SQL).The 28-day mortality in septic patients was regarded as major clinical outcome indicator,and 90-day mortality,hospital mortality,ICU mortality,the length of hospital and the length of ICU were regarded as secondary clinical outcome indicators.All study subjects were divided into four groups according to the AG quartiles,the baseline data of the four groups of patients were compared,and the relationship between AG and clinical outcome indicators was evaluated in each group.Then the Kaplan-Meier survival curve and Cox regression prediction curve were used to explore the relationship between each group of septic patients and the 28-day mortality,and the Log-rank test were used to assess survival differences,in order to correct for potential confounding factors,different Cox risk regression models were established for multivariate regression analysis.In addition,the area under the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of AG for 28-day mortality in septic patients,and compared with some indicators that clearly have clinical value.Finally,subgroup analysis was used to explore the correlation between AG and other variables on the 28-day mortality of patients with sepsis.Results 1.According to the inclusion and exclusion criteria,a total of 10175 patients met the criteria.All patients were categorized by the first AG after admission,they were Q1(AG<12,n=2208),Q2(12≤AG<14,n=2313),Q3(14≤AG<16,n=2389)and Q4(AG ≥ 16,n=3265).The results showed that with the increase of AG,from Q1 to Q4,the 28-day mortality(12.3% vs 14.2% vs 16.5% vs25.6%),90-day mortality(20.6% vs 23.9% vs 25.4% vs 36.0%,P<0.001),hospital mortality(11.3% vs 13.6% vs 15.0% vs 23.5%,P<0.001),ICU mortality(7.6% vs8.8% vs 10.0% vs 16.8%,P<0.001)and the length of ICU(2.89 vs 2.91 vs 2.87 vs3.15,P<0.001)were significant differences,but in the length of hospital(10.5 vs9.98 vs 9.86 vs 10.04,P=0.241),there was no difference.2.In the Kaplan-Meier survival curve analysis of the 28-day mortality of septic patients,it was found that with the hospital length of patients extended,the higher the AG value,the more obvious the survival decline,and the Log-rank test showed a significant difference in survival(P<0.001),which was highly consistent with the Cox regression prediction curve.In addition,in different Cox regression models,based on Q1 as the reference group,in model 1(uncorrected),the HR values of Q2-Q4 increased from 1.16(95%CI: 0.98-1.36)to 2.26(95%CI: 1.97-2.60).In model 2(corrected for age and gender),the HR value increased from 1.14(95%CI:0.97-1.34)to 2.26(95%CI: 1.97-2.60).In model 3(on the basis of Model 2,corrected for heart rate,systolic blood pressure,serum creatinine,serum potassium,SOFA score,etc),the HR value increased from 1.09(95%CI: 0.92-1.28)to 1.61(95%CI:1.38-1.88).Although the HR value decreased,there were still significant differences(P<0.001).3.The area under the ROC curve of AG,SAPSII,SOFA,Scr,and RDW at28-day mortality in septic patients were 0.609,0.726,0.656,0.600,0.619,respectively.Compared with AG,SAPSII and SOFA have better clinical value(P<0.001),Whereas,there was no significant difference among AG,RDW and Scr(P=0.071).4.In the subgroup analysis,it was found that higher AG was associated with higher 28-day mortality in septic patients with systolic blood pressure <115mm Hg,combined with congestive heart failure,Scr≥1.1mg/d L,PT≥14s,and SOFA score≥5,etc.Conclusion AG may be an effective indicator for predicting the short-term prognosis of patients with sepsis,which has the same clinical value as RDW and Scr.What’s more,with the increase of AG value,the mortality of 28-day is higher in septic patients with systolic blood pressure<115mm Hg,congestive heart failure,Scr≥1.1mg/d L,and SOFA≥5 score,etc. |
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