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Combining the anion gap with the sequential organ failure assessment score to evaluate the short-term prognosis of patients in the cardiac intensive care unit

  • Yuan-Hang Zhou
    Affiliations
    Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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  • Shuo Pang
    Affiliations
    Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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  • Guang-Rui Miao
    Affiliations
    Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Xiao-Yan Zhao
    Correspondence
    Corresponding author.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    Search for articles by this author
  • Jian-Zeng Dong
    Affiliations
    Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

    Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Published:November 01, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.10.175

      Highlights

      • Anion gap (AG) is associated with mortality of cardiac intensive care patients.
      • The first-day Sequential Organ Failure Assessment (SOFA) score was also evaluated.
      • Combining the AG and SOFA score significantly improved the prediction ability.

      Abstract

      Background

      We attempted to determine the predictive ability of the first-day Sequential Organ Failure Assessment (SOFA) score in the cardiac intensive care unit, as well as a new score combining the anion gap (AG) with the SOFA score (SOFA-AG).

      Methods

      Information was obtained from the Medical Information Mart for Intensive Care III (MIMIC III 1.4) database. We plotted the relationship between the maximum first-day AG and 90-day mortality after admission to the care unit. Patients were divided into five groups based on the hazard ratio (HR) and assigned scores of 0, 1, 2, 3, or 4 points. We compared the area under the curve (AUC) for the receiver-operating characteristic curve of the SOFA and that of the SOFA-AG.

      Results

      A total of 1316 patients were identified and divided into the following five groups: AG 8 to <16 mmol/L; AG 16 to <17 mmol/L; AG 17 to <19 mmol/L; AG 19 to <21 mmol/L; and AG ≥ 21 mmol/L. The SOFA-AG score had a greater AUC than the SOFA score at 7 days (0.770 vs. 0.711; P < 0.001), 14 days (0.751 vs. 0.692; P < 0.001), 28 days (0.741 vs. 0.684; P < 0.001), and 90 days (0.727 vs. 0.667; P < 0.001).

      Conclusions

      The SOFA score showed moderate predictive value only for 7-day mortality after admission to the cardiac intensive care unit, but the SOFA-AG score had improved predictive ability for up to 90 days after admission.

      Keywords

      Abbreviations:

      95% CI (95% Confidence interval), ACEI (angiotensin converting enzyme inhibitors), ARB (angiotensin-II-receptor blockers), APTT (activated partial thromboplastin times), BE (base excess), HCT (red blood cell specific volume), HR (hazard ratio), ICD (International Classification of Diseases), ICU (Intensive Care Unit), MIMIC (Medical Information Mart for Intensive Care), MRA (mineralocorticoid receptor antagonists), PCO2 (partial pressure of carbon dioxide), pH (measure of acidity or alkalinity), PO2 (partial pressure of carbon oxygen), PT (prothrombin time), RCS (restricted cubic splines), SD (standard deviation), tCO2 (total carbon dioxide), WBC (white blood cells)
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      Linked Article

      • Is anion gap helpful for assessing cardiovascular risk in cardiac intensive care unit?
        International Journal of Cardiology
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          In recent years, there is a growing importance of the cardiac intensive care unit (CICU), which is evolved from the conventional coronary care unit (CCU), due to the increasing complexity of CCU patients. [1–3] Cardiac intensivists are exposed to an increasing amount of non-cardiac organ failures. To date, several scoring methods to stratify the prognosis in critically ill patients, such as sequential organ failure assessment (SOFA) score, acute physiologic and chronic health evaluation (APACHE), and simplified acute physiology score (SAPS), have been developed in the general intensive care unit because early detection of risk factors is beneficial.
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