白蛋白纠正了败血症重症监护患者的阴离子间隙和死亡率：使用重症监护IV医疗信息集市的分析
Albumin-Corrected Anion Gap And Mortality In Septic Intensive Care Patients: An Analysis Using Medical Information Mart For Intensive Care IV.
摘要(中文译文)
早期预后评估对重症监护病房（ICU）脓毒症患者至关重要。本研究探讨了白蛋白校正阴离子间隙（ACAG）与ICU脓毒症患者临床结局之间的关系。本回顾性队列研究分析了来自MIMIC-IV（2.2版）数据库的8，286例脓毒症患者。主要结局为30天院内死亡率和30天ICU死亡率。作者采用Kaplan-Meier分析、log-rank检验、多变量Cox回归和限制性立方样条（RCS）回归评估ACAG与结局之间的关联。亚组分析评估了不同因素间的一致性。较高的ACAG水平与死亡风险增加显著相关。作为连续变量，ACAG在完全校正模型中独立预测较高的院内死亡率（HR 1.01，95% CI 1.01-1.02，p < 0.001）。四分位分析显示，在完全校正模型中，Q4组患者（ACAG > 26.62）的院内死亡风险较Q1组高41%（HR 1.41，95% CI 1.24-1.49，p < 0.001）。对于ICU死亡率，Q4组风险较Q1组高54%（HR 1.54，95% CI 1.41-1.75，p < 0.001），尽管连续ACAG在完全校正模型中不显著（p = 0.099），提示存在阈值效应。RCS分析识别出非线性关联，拐点为ACAG = 23。亚组分析证实效应一致，体重指数、急性肾损伤、连续性肾脏替代治疗和机械通气存在显著交互作用。较高的ACAG水平与ICU脓毒症患者30天死亡率增加显著相关，呈非线性模式，拐点为23。监测ACAG可能有助于危重脓毒症患者的风险评估，尤其是当数值超过该阈值时。需要进一步研究以阐明机制并验证临床实用性。
Abstract
Early prognostic assessment is crucial for sepsis patients in intensive care units (ICU). This study investigated the relationship between the albumin-corrected anion gap (ACAG) and clinical outcomes in ICU patients with sepsis. This retrospective cohort study analyzed 8,286 sepsis patients from the MIMIC-IV (version 2.2) database. Primary outcomes were 30-day in-hospital mortality and 30-day ICU mortality. The authors used Kaplan-Meier analysis, log-rank tests, multivariable Cox regression, and restricted cubic spline (RCS) regression to evaluate associations between ACAG and the outcome. Subgroup analyses assessed consistency across different factors. Higher ACAG levels were significantly associated with increased mortality risks. As a continuous variable, ACAG independently predicted higher in-hospital mortality in fully adjusted models (HR 1.01, 95% CI 1.01-1.02, p < 0.001). Quartile analysis revealed that Q4 patients (ACAG > 26.62) had 41% higher in-hospital mortality risk than Q1 in fully adjusted models (HR 1.41, 95% CI 1.24-1.49, p < 0.001). For ICU mortality, Q4 showed 54% higher risk than Q1 (HR 1.54, 95% CI 1.41-1.75, p < 0.001), although continuous ACAG was not significant in the fully adjusted model (p = 0.099), suggesting a threshold effect. RCS analysis identified a nonlinear association with an inflection point at ACAG = 23. Subgroup analyses confirmed consistent effects, with significant interactions for body mass index, acute kidney injury, continuous renal replacement therapy, and mechanical ventilation. Higher ACAG levels are significantly associated with increased 30-day mortality in ICU sepsis patients, showing a nonlinear pattern with an inflection point at 23. Monitoring ACAG may aid risk assessment in critically ill sepsis patients, particularly when values exceed this threshold. Further research is needed to elucidate mechanisms and validate clinical utility.
如何引用
AMA
Yaohua Yu, Hong Kong, Jiliang Li, Jiaqi Lou, Shengyong Cui, Sida Xu, et al. Albumin-Corrected Anion Gap And Mortality In Septic Intensive Care Patients: An Analysis Using Medical Information Mart For Intensive Care IV.. Journal of visualized experiments : JoVE. 2026; doi:10.3791/71800.
APA
Yaohua Yu, Hong Kong, Jiliang Li, Jiaqi Lou, Shengyong Cui, Sida Xu, et al (2026). Albumin-Corrected Anion Gap And Mortality In Septic Intensive Care Patients: An Analysis Using Medical Information Mart For Intensive Care IV.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/71800
GB/T 7714
Yaohua Yu, Hong Kong, Jiliang Li, Jiaqi Lou, Shengyong Cui, Sida Xu, et al. Albumin-Corrected Anion Gap And Mortality In Septic Intensive Care Patients: An Analysis Using Medical Information Mart For Intensive Care IV.[J]. Journal of visualized experiments : JoVE, 2026 doi:10.3791/71800.
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