一项比较强离子隙（SIG）与其他酸碱标志物在危重症患者中预后意义的队列研究。
A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study.
机构信息
Department of Intensive Care Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia ; School of Population Health, University of Western Australia, Perth, Australia ; School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
出版信息
J Intensive Care. 2016 Jun 29;4:43. doi: 10.1186/s40560-016-0166-z. eCollection 2016.
BACKGROUND
This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill.
METHODS
The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC).
RESULTS
Of the 6878 patients included in the study, 924 patients (13.4 %) died after ICU admission. Except for plasma chloride concentrations, all acid-base markers were significantly different between the survivors and non-survivors. SIG (with lactate: AUROC 0.631, confidence interval [CI] 0.611-0.652; without lactate: AUROC 0.521, 95 % CI 0.500-0.542) only had a modest ability to predict hospital mortality, and this was no better than using lactate concentration alone (AUROC 0.701, 95 % 0.682-0.721). Adding AG-corrected or SIG to a combination of lactate and MPM0 III predicted risks also did not substantially improve the latter's ability to differentiate between survivors and non-survivors. Arterial lactate concentrations explained about 11 % of the variability in the observed mortality, and it was more important than SIG (0.6 %) and SIDe (0.9 %) in predicting hospital mortality after adjusting for MPM0 III predicted risks. Lactate remained as the strongest predictor for mortality in a sensitivity multivariate analysis, allowing for non-linearity of all acid-base markers.
CONCLUSIONS
The prognostic significance of SIG was modest and inferior to arterial lactate concentration for the critically ill. Lactate concentration should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.
背景
本队列研究比较了在危重病患者中强离子间隙（SIG）与其他酸碱标志物的预后意义。
方法
分析了 6878 例患者在入住重症监护病房（ICU）后 1 小时内获得的 SIG、乳酸、阴离子间隙（AG）、阴离子间隙白蛋白校正（AG-corrected）、碱剩余或强离子差有效（SIDe）与 6878 例患者院内死亡率之间的关系。通过接受者操作特征曲线下面积（AUROC）评估每种酸碱标志物的预后意义，包括单独评估和与入院死亡率预测模型（MPM0 III）预测死亡率相结合的评估。
结果
在所纳入的 6878 例患者中，924 例（13.4%）患者在 ICU 入住后死亡。除了血浆氯浓度外，所有酸碱标志物在幸存者和非幸存者之间均有显著差异。SIG（伴有乳酸：AUROC 0.631，置信区间 [CI] 0.611-0.652；无乳酸：AUROC 0.521，95%CI 0.500-0.542）预测医院死亡率的能力仅为中等，且并不优于单独使用乳酸浓度（AUROC 0.701，95%CI 0.682-0.721）。将 AG-corrected 或 SIG 添加到乳酸和 MPM0 III 预测风险的组合中，也不能显著提高后者区分幸存者和非幸存者的能力。动脉乳酸浓度解释了观察死亡率的约 11%的变异性，在调整 MPM0 III 预测风险后，它比 SIG（0.6%）和 SIDe（0.9%）更重要，是预测医院死亡率的更强指标。在多变量敏感性分析中，乳酸仍然是死亡率的最强预测指标，因为所有酸碱标志物都存在非线性关系。
结论
SIG 的预后意义中等，逊于动脉乳酸浓度，因此对于危重病患者，应始终考虑乳酸浓度，而不论使用生理、碱剩余还是物理化学方法来解释危重病患者的酸碱紊乱。
Zotero 插件