血清阴离子间隙与 ICU 中 COPD 危重症患者死亡率的关系：来自 MIMIC IV 数据库的数据。
Association Between Serum Anion Gap and Mortality in Critically Ill Patients with COPD in ICU: Data from the MIMIC IV Database.
机构信息
Department of Respiratory and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, 010017, People's Republic of China.
NHC Key Laboratory of Diagnosis & Treatment of COPD, Inner Mongolia People's Hospital, Hohhot, 010017, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2024 Feb 29;19:579-587. doi: 10.2147/COPD.S433619. eCollection 2024.
BACKGROUND
Serum anion gap (AG) has been proven to be associated with prognosis in critically ill patients. However, few studies have investigated the association between AG and all-cause mortality in critically ill patients with chronic obstructive pulmonary disease (COPD).
OBJECTIVE
We hypothesized that the initial AG level would predict the mortality risk in critically ill patients with COPD.
METHODS
This retrospective cohort study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. We extracted demographics, vital signs, laboratory tests, comorbidity, and scoring systems from the first 24 hours after patient ICU admission. Multivariable logistic regression analysis models were used to explore the association between serum AG levels and mortality. Interaction and stratified analyses were conducted including age, gender and comorbidity.
RESULTS
A total of 5531 critically ill patients with COPD were enrolled, composed of 53.6% male and 46.4% female with a median age of 73 years. The all-cause mortality of these patients during ICU hospitalization was 13.7%. The risk of all-cause mortality increased as the AG level increased in the univariate logistic regression analysis (OR=1.13, 95% CI: 1.11-1.15, p<0.01). After adjusting for all the covariates in multivariate logistic regression analysis, the odds ratio was 1.06 (95% CI: 1.04-1.09, p<0.01). Compared with the lowest AG group Q1 (≤11mmol/L), the adjusted OR value for AG and mortality in Q2 (12-13mmol/L) was 0.89 (95% CI: 0.63-1.25, p=0.502), Q3 (14-15mmol/L) was 0.95 (95% CI: 0.68-1.34, p=0.788), and Q4 (≥16mmol/L) was 1.49 (95% CI: 1.10-2.02, p=0.009) respectively. In addition, the results of the subgroup and stratified analyses were robust.
CONCLUSION
AG is positively related to all-cause mortality in critically ill patients with COPD.
背景
血清阴离子间隙（AG）已被证明与危重症患者的预后相关。然而，很少有研究调查 AG 与慢性阻塞性肺疾病（COPD）危重症患者全因死亡率之间的关系。
目的
我们假设初始 AG 水平可预测 COPD 危重症患者的死亡风险。
方法
本回顾性队列研究基于医疗信息重症监护数据库（MIMIC）IV 数据库。我们从患者入住 ICU 后 24 小时内提取人口统计学、生命体征、实验室检查、合并症和评分系统。使用多变量逻辑回归分析模型探讨血清 AG 水平与死亡率之间的关系。进行了交互和分层分析，包括年龄、性别和合并症。
结果
共纳入 5531 例 COPD 危重症患者，其中 53.6%为男性，46.4%为女性，中位年龄为 73 岁。这些患者在 ICU 住院期间的全因死亡率为 13.7%。在单变量逻辑回归分析中，随着 AG 水平的升高，全因死亡率的风险呈上升趋势（OR=1.13，95%CI：1.11-1.15，p<0.01）。在校正多变量逻辑回归分析中的所有协变量后，比值比为 1.06（95%CI：1.04-1.09，p<0.01）。与最低 AG 组 Q1（≤11mmol/L）相比，AG 与 Q2（12-13mmol/L）的调整 OR 值为 0.89（95%CI：0.63-1.25，p=0.502），Q3（14-15mmol/L）为 0.95（95%CI：0.68-1.34，p=0.788），Q4（≥16mmol/L）为 1.49（95%CI：1.10-2.02，p=0.009）。此外，亚组和分层分析的结果是稳健的。
结论
AG 与 COPD 危重症患者的全因死亡率呈正相关。
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