Prognostic value of serum anion gap in patients with liver cirrhosis and sepsis

Pang Dongyu; Lin Hairong

doi:10.3969/j.issn.1672-8521.2023.02.002

Abstract：Objective:To investigate the prognostic value of serum anion gap(AG)in patients with cirrhosis complicated with sepsis.Methods:Structured query speech language(SQL)was used to extract the data of patients with cirrhosis complicated with sepsis from the intensive care medicine database(MIMIC-Ⅲ),and the in-hospital mortality was used as the main clinical outcome index.All subjects were divided into three groups according to the serum AG level in ICU,and the clinical data of the three groups were compared to evaluate the relationship between the collection of initial serum AG and clinical outcome indicators.Kaplan-Meier method was used to analyze the 180 days cumulative survival rate of patients with different levels of AG.The correlation between AG and prognosis of patients with cirrhosis complicated with sepsis was analyzed by univariate and multifactorial Logistic regression.The predictive performance of AG was evaluated by receiver operating curve(ROC).Results:A total of 866 patients with cirrhosis complicated with sepsis were enrolled,including group T1(AG≤11 mmol/L,n=360),group T2(11 mmol/L<AG≤14 mmol/L,n=260)and group T3(AG>14 mmol/L,n=246).The results of the study showed that the hospitalization mortality rate of patients in the T1 to T3 groups increased progressively with increasing AG levels(P < 0.001).In Kaplan-Meier survival curve,it was found that the higher the serum AG was over time,the more significant the decline in survival rate was.Univariate and multivariate Logistic regression analysis showed that AG level,sequential organ failure score(SOFA),bloodstream infection,and renal replacement therapy(RRT)were independent risk factors for the prognosis of cirrhosis complicated with sepsis.The AG level of the T1 group was taken as the reference,and the OR value of the T2 and T3 groups increased from 1.631 to 2.393(P < 0.05).ROC analysis showed that the area under ROC curve of AG to predict the prognosis of patients with cirrhosis and sepsis was 0.676(95%CI:0.638-0.714),and the AUC of combined SOFA score was 0.792(95%CI:0.761-0.824),the difference was statistically significant(P < 0.05).Conclusions:Serum AG may be an effective predictor of prognosis in patients with cirrhosis complicated with sepsis.