白蛋白校正阴离子间隙在充血性心力衰竭危重症患者中的独立预后重要性：一项来自MIMIC-IV数据库的回顾性研究

Independent prognostic importance of the albumin-corrected anion gap in critically ill patients with congestive heart failure: a retrospective study from MIMIC-IV database.

作者信息

Li Ni, Li Junling, Wang Kai

机构信息

Department of Cardiology, Bishan Hospital, Chongqing University of Chinese Medicine, 82 Xinsheng Road, Chongqing, 402760, China.

Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Chongqing, 401336, China.

出版信息

BMC Cardiovasc Disord. 2024 Dec 20;24(1):735. doi: 10.1186/s12872-024-04422-9.

DOI:10.1186/s12872-024-04422-9

PMID:39707198

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11660767/

Abstract

BACKGROUND

The associations between the albumin-corrected anion gap (ACAG) and all-cause mortality in patients with congestive heart failure in the intensive care unit remain uncertain. This study aimed to investigate this unknown.

METHODS

The MIMIC-IV (version 3.0) database was used to analyze critically ill patients with congestive heart failure. Patients were grouped into tertiles (T1-T3) on the basis of the ACAG. The association between ACAG levels and 1-year all-cause mortality was assessed using Kaplan-Meier survival analyses, multivariate adjusted Cox regression models, and restricted cubic spline curves. An analysis of subgroups was performed to evaluate ACAG's prognostic impact across diverse populations. Mediation analysis was conducted to identify and elucidate potential causal pathways linking ACAG to all-cause mortality.

RESULTS

A cohort of 7787 patients was analyzed. On the basis of Kaplan-Meier curves, Cox regression, restricted cubic spline curves and subgroup analysis, T2 (hazard ratio 1.09, 95% confidence interval 1.02 ~ 1.16) and T3 (hazard ratio 1.25, 95% confidence interval 1.17 ~ 1.33) individuals presented a greater mortality risk compared to T1 individuals (p for linear trend < 0.001), and most subgroups consistently observed this relationship, except for those with different levels of left ventricular ejection fraction. Mediation analysis indicated that the red cell distribution width, stage of acute kidney injury, chloride and acute physiology score III partially mediated the relationship between ACAG and mortality, accounting for 12.4%, 7.0%, 12.9%, and 31.2% of the mediating effect, respectively.

CONCLUSIONS

The ACAG was associated with higher 1-year all-cause mortality in critically ill patients with congestive heart failure, with stronger impact in those with lower left ventricular ejection fractions. The ACAG may serve as an indicator in high-risk groups.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

在重症监护病房的充血性心力衰竭患者中，白蛋白校正阴离子间隙（ACAG）与全因死亡率之间的关联仍不确定。本研究旨在探究这一未知问题。

方法

使用MIMIC-IV（版本3.0）数据库分析重症充血性心力衰竭患者。根据ACAG将患者分为三分位数组（T1 - T3）。使用Kaplan-Meier生存分析、多变量调整Cox回归模型和受限立方样条曲线评估ACAG水平与1年全因死亡率之间的关联。进行亚组分析以评估ACAG在不同人群中的预后影响。进行中介分析以识别和阐明将ACAG与全因死亡率联系起来的潜在因果途径。

结果

分析了7787例患者的队列。根据Kaplan-Meier曲线、Cox回归、受限立方样条曲线和亚组分析，与T1组个体相比，T2组（风险比1.09，95%置信区间1.02 ~ 1.16）和T3组（风险比1.25，95%置信区间1.17 ~ 1.33）个体的死亡风险更高（线性趋势p < 0.001），除左心室射血分数不同的亚组外，大多数亚组均一致观察到这种关系。中介分析表明，红细胞分布宽度、急性肾损伤分期、氯和急性生理学评分III部分介导了ACAG与死亡率之间的关系，分别占中介效应的12.4%、7.0%、12.9%和31.2%。