Zampieri Fernando Godinho, Park Marcelo, Ranzani Otavio Tavares, Maciel Alexandre Toledo, de Souza Heraldo Possolo, da Cruz Neto Luiz Monteiro, da Silva Fabiano Pinheiro
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil.
Rev Bras Ter Intensiva. 2013 Jul-Sep;25(3):205-11. doi: 10.5935/0103-507X.20130036.
Corrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality.
We included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2 mEq/L (low BE group - lBE) and the other in patients with base-excess >-2 mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality.
There was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression.
Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.
校正阴离子间隙和强离子间隙常用于估计未测定阴离子。我们评估了校正白蛋白、磷酸盐和乳酸后的阴离子间隙在预测危重症患者混合群体中强离子间隙方面的性能。我们假设校正白蛋白、磷酸盐和乳酸后的阴离子间隙将是强离子间隙的良好预测指标，与代谢性酸中毒的存在无关。此外，我们评估了入院时强离子间隙对医院死亡率的影响。
我们纳入了84例危重症患者。通过Pearson相关检验、线性回归、Bland-Altman图和计算组内相关系数，评估校正白蛋白、磷酸盐和乳酸后的阴离子间隙与强离子间隙之间的相关性和一致性。进行了两项亚组分析：一项针对碱剩余<-2 mEq/L的患者（低碱剩余组-lBE），另一项针对碱剩余>-2 mEq/L的患者（高碱剩余组-hBE）。进行逻辑回归以评估入院时强离子间隙水平与医院死亡率之间的关联。
在总体人群中，校正白蛋白、磷酸盐和乳酸后的阴离子间隙与强离子间隙之间存在非常强的相关性和良好的一致性（r2=0.94；偏差1.40；一致性界限为-0.75至3.57）。在lBE组（r2=0.94）和hBE组（r2=0.92）中相关性也很高。在整个人口中，66%的患者存在高水平的强离子间隙，在hBE组中这一比例为42%。通过逻辑回归分析，强离子间隙与医院死亡率无关。
校正白蛋白、磷酸盐和乳酸后的阴离子间隙与强离子间隙具有极好的相关性。在碱剩余正常的危重症患者中，未测定阴离子经常升高。然而，未测定阴离子与医院死亡率之间没有关联。
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