Wen Yong, Xie Xiaorui, He Keli
Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The first People's hospital of Changde City), Changde, 415000, Hunan, China.
Department of Neurology, Xiangya Changde Hospital, Changde, 415000, Hunan, China.
Eur J Med Res. 2025 Jul 2;30(1):546. doi: 10.1186/s40001-025-02810-1.
Non-traumatic intracerebral hemorrhage (ICH) is a significant cause of mortality and disability. The search for reliable prognostic markers to assess the risk of mortality in non-traumatic ICH patients is imperative. This study aimed to investigate the association between serum anion gap (AG) and mortality in critically ill patients with non-traumatic ICH.
We conducted a retrospective cohort study of patients with non-traumatic ICH from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Baseline characteristics were analyzed and stratified by AG quartiles. Univariate and multivariate Cox regression analyses were performed to assess the effect of AG on 28-day and 180-day mortality. Kaplan-Meier survival curves and restricted cubic spline analysis explored the relationship between AG quartiles and mortality and potential non-linear relationships, respectively. In addition, we tested for incremental effects of AG. Finally, we performed subgroup analyses to identify patient characteristics that may modify the relationship between AG and mortality.
A total of 1,619 patients with non-traumatic ICH were enrolled in this study, with a mean age of 68.11 years, of them, 886 were males (54.73%). Cox regression analysis showed a significant association between AG and mortality, with each one-unit increase in AG increasing the risk of 28-day mortality by 8% and 180-day mortality by 6% in fully adjusted models. Kaplan-Meier analysis showed that the higher the AG quartile, the lower the probability of survival. Restricted cubic spline analysis showed a significant linear relationship between AG and risk of death. In addition, AG significantly improved the predictive performance of the base model for mortality in patients with non-traumatic ICH. Finally, subgroup analyses identified diabetes as a factor that significantly modified the relationship between AG and mortality in patients with non-traumatic ICH.
The study demonstrates the prognostic value of AG in non-traumatic ICH, especially in diabetic patients. Future prospective studies are warranted to validate these findings.
非创伤性脑出血（ICH）是导致死亡和残疾的重要原因。寻找可靠的预后标志物以评估非创伤性ICH患者的死亡风险迫在眉睫。本研究旨在探讨血清阴离子间隙（AG）与非创伤性ICH重症患者死亡率之间的关联。
我们对重症监护医学信息数据库IV（MIMIC-IV）中患有非创伤性ICH的患者进行了一项回顾性队列研究。分析基线特征并按AG四分位数进行分层。进行单因素和多因素Cox回归分析以评估AG对28天和180天死亡率的影响。Kaplan-Meier生存曲线和受限立方样条分析分别探讨了AG四分位数与死亡率之间的关系以及潜在的非线性关系。此外，我们测试了AG的增量效应。最后，我们进行亚组分析以确定可能改变AG与死亡率之间关系的患者特征。
本研究共纳入1619例非创伤性ICH患者，平均年龄68.11岁，其中886例为男性（54.73%）。Cox回归分析显示AG与死亡率之间存在显著关联，在完全调整模型中，AG每增加一个单位，28天死亡率风险增加8%，180天死亡率风险增加6%。Kaplan-Meier分析表明，AG四分位数越高，生存概率越低。受限立方样条分析显示AG与死亡风险之间存在显著的线性关系。此外，AG显著提高了非创伤性ICH患者死亡率基础模型的预测性能。最后，亚组分析确定糖尿病是显著改变非创伤性ICH患者中AG与死亡率之间关系的一个因素。
该研究证明了AG在非创伤性ICH中的预后价值，尤其是在糖尿病患者中。未来有必要进行前瞻性研究以验证这些发现。
