ACAG与肝衰竭患者短期死亡率的相关性：基于MIMIC-IV数据库的回顾性分析
Association of ACAG with short-term mortality in liver failure patients: a retrospective analysis based on the MIMIC-IV database.
摘要(中文译文)
传统评分系统难以为肝衰竭的早期诊断和干预提供支持。尽管白蛋白校正阴离子间隙（ACAG）可预测多种疾病的不良结局，但其在肝衰竭中的有效性仍不明确。本研究分析了MIMIC-IV数据库中的肝衰竭患者，按ACAG四分位数分为Q1至Q4组。采用Kaplan-Meier生存曲线检验各组间死亡率差异。通过Cox回归和限制性立方样条（RCS）分析探讨ACAG与死亡率的关系。此外，我们采用受试者工作特征（ROC）曲线分析比较ACAG、MELD及其联合模型对死亡率的预测效能，计算曲线下面积（AUC），并使用DeLong检验比较AUC值。最后，进行亚组分析以评估ACAG与不同类型肝衰竭预后的关系。本研究共纳入2，016例肝衰竭患者，30天和90天死亡率分别为27.23%和30.01%。Kaplan-Meier生存曲线显示死亡率随ACAG水平升高而增加。多因素Cox回归证实ACAG与死亡率呈正相关[HR 1.032（30天）、1.031（90天）；均P < 0.001]，RCS显示为线性关系。30天死亡率的AUC分别为0.641（ACAG）、0.634（MELD）和0.668（联合模型）；90天死亡率的相应值分别为0.630、0.621和0.654。联合模型的AUC在30天和90天死亡率方面均显著高于单独ACAG（P = 0.0009和0.0016）和单独MELD（P = 0.0004和0.0002）。尽管ACAG的AUC略高于MELD，但DeLong检验表明差异无统计学意义（30天和90天死亡率分别为P = 0.7035和0.5387）。亚组分析在年龄亚组和CRRT亚组中观察到交互作用；在所有肝衰竭亚型中，非存活者的ACAG均持续升高。本研究表明，ACAG指数与肝衰竭患者死亡率显著相关；其与MELD评分联合可进一步提高预测准确性。
Abstract
Traditional scoring systems are challenging for early diagnosis and intervention in liver failure. While albumin-corrected anion gap (ACAG) predicts adverse outcomes in various conditions, its effectiveness in liver failure remains unclear. This study analyzed hepatic failure patients from MIMIC-IV, stratified into Q1-Q4 by ACAG quartiles. Kaplan-Meier survival curves examined mortality differences. The connection of ACAG with mortality was examined using Cox regression and restricted cubic spline (RCS) analyses. Additionally, we compared the predictive performance of ACAG, MELD, and their combination for mortality using receiver operating characteristic (ROC) curve analysis, calculated the area under the curve (AUC), and compared the AUC values using the DeLong test. Finally, subgroup analyses were conducted to evaluate the relationship between ACAG and prognosis in different types of liver failure. Current study involving 2,016 patients with liver failure revealed 30- and 90-day mortality rates of 27.23% and 30.01%, respectively. Kaplan-Meier survival curves demonstrated mortality increased with ACAG levels. Multivariate Cox regression confirmed ACAG’s positive association with mortality [HR 1.032 (30-day), 1.031 (90-day); both P < 0.001], and the RCS showed a linear relationship. The AUCs for 30-day mortality were 0.641 (ACAG), 0.634 (MELD), and 0.668 (combined); the corresponding values for 90-day mortality were 0.630, 0.621, and 0.654. The AUC of the combined model was significantly higher than that of ACAG alone (P = 0.0009 and 0.0016) and MELD alone (P = 0.0004 and 0.0002) for 30- and 90-day mortality, respectively. Although ACAG yielded a marginally higher AUC than MELD, DeLong’s test indicated no significant difference (P = 0.7035 and 0.5387 for 30-and 90-day mortality, respectively). Subgroup analyses observed interactions in the age subgroups and CRRT subgroups; ACAG was consistently elevated in non-survivors across all liver-failure subtypes. Our study demonstrates that the ACAG index is significantly associated with mortality in patients with hepatic failure; its integration with the MELD score further enhances predictive accuracy.
如何引用
AMA
Hang Wang, Shuangli Li, Shunhao Lai, Yunjian Sheng. Association of ACAG with short-term mortality in liver failure patients: a retrospective analysis based on the MIMIC-IV database.. Scientific reports. 2026; doi:10.1038/s41598-026-39253-5.
APA
Hang Wang, Shuangli Li, Shunhao Lai, Yunjian Sheng (2026). Association of ACAG with short-term mortality in liver failure patients: a retrospective analysis based on the MIMIC-IV database.. Scientific reports. https://doi.org/10.1038/s41598-026-39253-5
GB/T 7714
Hang Wang, Shuangli Li, Shunhao Lai, Yunjian Sheng. Association of ACAG with short-term mortality in liver failure patients: a retrospective analysis based on the MIMIC-IV database.[J]. Scientific reports, 2026 doi:10.1038/s41598-026-39253-5.
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