Dafal Akshay, Kumar Sunil, Agrawal Sachin, Acharya Sourya, Nirmal Apoorva
Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
J Lab Physicians. 2021 Jun;13(2):107-111. doi: 10.1055/s-0041-1726568. Epub 2021 Jun 25.
Anion gap (AG) metabolic acidosis is common in critically ill patients. The relationship between initial AG at the time of admission to the medical intensive care unit (MICU) and mortality or length of stay is unclear. This study was undertaken to evaluate this relationship. We prospectively examined the acid-base status of 500 consecutive patients at the time of MICU admission and outcome was measured in terms of mortality, length of ICU stay, need of ventilator, and laboratory parameters. The patients were divided into four stages based on the severity of AG. Outcome based on the severity of AG was measured, and comparisons that adjusted for baseline characteristics were performed. This study showed that increased AG was associated with the higher mortality. Patients with the highest AG also had the longest length of stay in the MICU, and patients with normal acid-base status had the shortest ICU length of stays ( < 0.05). A high AG at the time of admission to the MICU was associated with higher mortality and length of stays. Initial risk stratification based on AG and metabolic acidosis may help guide appropriate patient disposition (especially in patients without other definitive criteria for MICU admission) and assist with prognosis.
阴离子间隙（AG）代谢性酸中毒在重症患者中很常见。入住医学重症监护病房（MICU）时的初始AG与死亡率或住院时间之间的关系尚不清楚。本研究旨在评估这种关系。
我们前瞻性地检查了500例连续入住MICU患者的酸碱状态，并根据死亡率、ICU住院时间、呼吸机需求和实验室参数来衡量结果。根据AG的严重程度将患者分为四个阶段。测量基于AG严重程度的结果，并进行了针对基线特征进行调整的比较。
本研究表明，AG升高与较高的死亡率相关。AG最高的患者在MICU的住院时间也最长，而酸碱状态正常的患者在ICU的住院时间最短（<0.05）。
入住MICU时的高AG与较高的死亡率和住院时间相关。基于AG和代谢性酸中毒的初始风险分层可能有助于指导适当的患者处置（特别是在没有其他明确的MICU入住标准的患者中）并辅助预后评估。
