急性心肌梗死患者血清阴离子间隙与全因死亡率的关联：一项基于MIMIC-IV数据库的回顾性研究
Association between serum anion gap and all-cause mortality in patients with acute myocardial infarction: A retrospective study based on MIMIC-IV database.
作者信息
Lu Jianhong, Zhong Lei, Yuan Meng, Min Jie, Xu Yin
机构信息
Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Huzhou Hospital, School of Medicine, Zhejiang University, Huzhou, 313000, China.
Department of General Practice, Huzhou Central Hospital, Affiliated Huzhou Hospital, School of Medicine, Zhejiang University, China.
出版信息
Heliyon. 2023 Jun 27;9(7):e17397. doi: 10.1016/j.heliyon.2023.e17397. eCollection 2023 Jul.
BACKGROUND
Although previous studies have reported that many biomarkers can determine the prognosis of patients with acute myocardial infarction (AMI), serum anion gap (AG) has not been well studied. We aimed to investigate the association between serum AG and mortality in patients with AMI.
METHODS
Adult patients first admitted to the ICU and diagnosed with AMI from 2008 to 2019 in the MIMIC-IV database were included. Patients were divided into the survival and non-survival groups based on 30-day and 90-day outcomes. According to the AG value (15.12 mmol/L) with a hazard ratio of 1 in the restricted cubic spline (RCS) analysis, patients were further divided into high and low AG groups. The Kaplan-Meier survival curve was plotted, and all-cause mortality was compared between the high and low groups using the log-rank test. Multivariate Cox regression analysis and RCS analysis were constructed to assess the relationship between AG and recent all-cause mortality in patients with AMI.
RESULTS
4446 patients were enrolled. The 30-day and 90-day mortality rates in the high AG group (25.53%, 31.75%) were higher than that in the low AG group (9.73%, 14.01%, < 0.001) independently. The Kaplan-Meier curve showed that the 30-day and 90-day cumulative survival rates were lower in the high AG group than that in the low AG group ( < 0.001). RCS analysis showed that there was a non-linear relationship between AG and the risk of 90-day all-cause mortality in patients with AMI (χ2 = 18.680 < 0.001). When AG was 15.12 mmol/L, its HR was about 1. Multivariable Cox regression analysis confirmed that increased AG was associated with higher 30-day and 90-day mortality.
CONCLUSION
Elevated serum AG (≥15.12 mmol/L) is an independent predictor for short-term mortality in patients with AMI, and it may provide a basis for clinicians to identify patients with poor prognosis as early as possible.
背景
尽管先前的研究报告称许多生物标志物可用于确定急性心肌梗死（AMI）患者的预后，但血清阴离子间隙（AG）尚未得到充分研究。我们旨在探讨血清AG与AMI患者死亡率之间的关联。
方法
纳入2008年至2019年首次入住重症监护病房（ICU）并被诊断为AMI的成年患者。根据30天和90天的结局将患者分为存活组和非存活组。在受限立方样条（RCS）分析中，根据AG值（15.12 mmol/L）且风险比为1，将患者进一步分为高AG组和低AG组。绘制Kaplan-Meier生存曲线，并使用对数秩检验比较高AG组和低AG组之间的全因死亡率。构建多变量Cox回归分析和RCS分析以评估AG与AMI患者近期全因死亡率之间的关系。
结果
共纳入4446例患者。高AG组的30天和90天死亡率（25.53%，31.75%）独立高于低AG组（9.73%，14.01%，P<0.001）。Kaplan-Meier曲线显示，高AG组的30天和90天累积生存率低于低AG组（P<0.001）。RCS分析显示，AG与AMI患者90天全因死亡风险之间存在非线性关系（χ2=18.680，P<0.001）。当AG为15.12 mmol/L时，其风险比约为1。多变量Cox回归分析证实，AG升高与30天和90天死亡率升高相关。
结论
血清AG升高（≥15.12 mmol/L）是AMI患者短期死亡率的独立预测因素，可为临床医生尽早识别预后不良患者提供依据。
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