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    A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study

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    Access Status
    Open access
    Authors
    Ho, K.
    Lan, N.
    Williams, Teresa
    Harahsheh, Y.
    Chapman, A.
    Dobb, G.
    Magder, S.
    Date
    2016
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Ho, K. and Lan, N. and Williams, T. and Harahsheh, Y. and Chapman, A. and Dobb, G. and Magder, S. 2016. A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study. Journal of Intensive Care. 4 (43): pp. 1-11.
    Source Title
    J Intensive Care
    DOI
    10.1186/s40560-016-0166-z
    School
    School of Nursing and Midwifery
    Remarks

    This open access article is distributed under the Creative Commons license https://creativecommons.org/licenses/by/4.0/

    URI
    http://hdl.handle.net/20.500.11937/19081
    Collection
    • Curtin Research Publications
    Abstract

    BACKGROUND: This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill. METHODS: The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC). RESULTS: Of the 6878 patients included in the study, 924 patients (13.4 %) died after ICU admission. Except for plasma chloride concentrations, all acid-base markers were significantly different between the survivors and non-survivors. SIG (with lactate: AUROC 0.631, confidence interval [CI] 0.611-0.652; without lactate: AUROC 0.521, 95 % CI 0.500-0.542) only had a modest ability to predict hospital mortality, and this was no better than using lactate concentration alone (AUROC 0.701, 95 % 0.682-0.721). Adding AG-corrected or SIG to a combination of lactate and MPM0 III predicted risks also did not substantially improve the latter's ability to differentiate between survivors and non-survivors. Arterial lactate concentrations explained about 11 % of the variability in the observed mortality, and it was more important than SIG (0.6 %) and SIDe (0.9 %) in predicting hospital mortality after adjusting for MPM0 III predicted risks. Lactate remained as the strongest predictor for mortality in a sensitivity multivariate analysis, allowing for non-linearity of all acid-base markers. CONCLUSIONS: The prognostic significance of SIG was modest and inferior to arterial lactate concentration for the critically ill. Lactate concentration should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.

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