A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study
dc.contributor.author | Ho, K. | |
dc.contributor.author | Lan, N. | |
dc.contributor.author | Williams, Teresa | |
dc.contributor.author | Harahsheh, Y. | |
dc.contributor.author | Chapman, A. | |
dc.contributor.author | Dobb, G. | |
dc.contributor.author | Magder, S. | |
dc.date.accessioned | 2017-01-30T12:11:49Z | |
dc.date.available | 2017-01-30T12:11:49Z | |
dc.date.created | 2016-08-30T19:30:18Z | |
dc.date.issued | 2016 | |
dc.identifier.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. | |
dc.identifier.uri | http://hdl.handle.net/20.500.11937/19081 | |
dc.identifier.doi | 10.1186/s40560-016-0166-z | |
dc.description.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. | |
dc.title | A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study | |
dc.type | Journal Article | |
dcterms.source.volume | 4 | |
dcterms.source.startPage | 43 | |
dcterms.source.endPage | 43 | |
dcterms.source.title | J Intensive Care | |
curtin.note |
This open access article is distributed under the Creative Commons license | |
curtin.department | School of Nursing and Midwifery | |
curtin.accessStatus | Open access |