Wang Jianjun, Peng Yonghai, Hu Zhaohui, Chen Xi, Chen Sirui, Yang Pei, Zeng Xintao, Wang Decai
Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
BMC Infect Dis. 2025 Jul 19;25(1):928. doi: 10.1186/s12879-025-11321-7.
Albumin-corrected anion gap (ACAG) is closely associated with the prognosis of many critical illnesses. However, the prognostic value of ACAG in sepsis-associated liver injury (SALI) is poorly understood. We explored the association between ACAG and patient prognosis in individuals diagnosed with SALI.
Data from patients with SALI admitted to the intensive care unit (ICU) between 2008 and 2022 were retrospectively analyzed. ACAG was calculated based on the first measurement of the anion gap and albumin level within 24 h of admission. The optimal cutoff value for ACAG was established using R statistical software. Kaplan-Meier analysis was conducted to compare mortality risks between the two groups, while multivariable Cox proportional hazards regression models were employed to examine the association between ACAG and mortality risk in SALI patients. To assess a potential dose-response relationship, restricted cubic splines (RCS) were applied. Lastly, subgroup analyses were carried out to investigate the correlation between ACAG levels and prognosis across different patient populations.
A total of 443 critically ill patients with SALI were included in the lower (n = 342) and higher ACAG (n = 101) groups based on ACAG levels. No statistically significant differences were observed between the two groups regarding age, sex, or ethnicity (P = 0.12, 0.84, and 0.85, respectively). However, patients in the higher ACAG group exhibited a greater propensity for developing respiratory failure. The rates of ICU, in-hospital, 14-day, 28-day, and 90-day mortality were significantly elevated in the higher ACAG group (all P < 0.001). Higher ACAG levels were significantly associated with an increased mortality risk at multiple time points (all P < 0.001). ACAG levels and mortality showed a significant linear relationship. The impact of ACAG on mortality risk remained consistent across subgroups defined by age, sex, hypertension, diabetes, and respiratory failure, with no significant interactions observed (all P for interaction > 0.05).
ACAG serves as a significant independent predictor of mortality risk in patients with SALI. ACAG predicts both short-term mortality risk (such as ICU mortality) and long-term mortality risk (such as 90-day mortality). ACAG may serve as a valuable tool for prognostic assessment in patients with SALI with broad applicability.
白蛋白校正阴离子间隙（ACAG）与许多危重病的预后密切相关。然而，ACAG在脓毒症相关性肝损伤（SALI）中的预后价值尚不清楚。我们探讨了ACAG与诊断为SALI的患者预后之间的关联。
回顾性分析2008年至2022年入住重症监护病房（ICU）的SALI患者的数据。ACAG基于入院后24小时内首次测量的阴离子间隙和白蛋白水平进行计算。使用R统计软件确定ACAG的最佳截断值。进行Kaplan-Meier分析以比较两组之间的死亡风险，同时使用多变量Cox比例风险回归模型来检验ACAG与SALI患者死亡风险之间的关联。为了评估潜在的剂量反应关系，应用了受限立方样条（RCS）。最后，进行亚组分析以研究不同患者群体中ACAG水平与预后之间的相关性。
根据ACAG水平，共443例重症SALI患者被纳入低ACAG组（n = 342）和高ACAG组（n = 101）。两组在年龄、性别或种族方面未观察到统计学上的显著差异（P分别为0.12、0.84和0.85）。然而，高ACAG组患者发生呼吸衰竭的倾向更大。高ACAG组的ICU、住院、14天、28天和90天死亡率均显著升高（所有P < 0.001）。较高的ACAG水平在多个时间点与死亡风险增加显著相关（所有P < 0.001）。ACAG水平与死亡率呈显著线性关系。ACAG对死亡风险的影响在按年龄、性别、高血压、糖尿病和呼吸衰竭定义的亚组中保持一致，未观察到显著的相互作用（所有交互作用P > 0.05）。
ACAG是SALI患者死亡风险的重要独立预测指标。ACAG可预测短期死亡风险（如ICU死亡率）和长期死亡风险（如90天死亡率）。ACAG可能是SALI患者预后评估的有价值工具，具有广泛的适用性。
