Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by ...Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.展开更多
Diabetes mellitus is the most common metabolic disorder occasioned by derangement in glucose equilibration between the ECF and ICF. The derangement is known to affect the appropriate balance of electrolytes that serve...Diabetes mellitus is the most common metabolic disorder occasioned by derangement in glucose equilibration between the ECF and ICF. The derangement is known to affect the appropriate balance of electrolytes that serves as a buffer in the body. In this study anion gap was evaluated among outpatient diabetics as compared to non-diabetics control group. The categorization into the study or control groups was done by serum glucose estimation using glucose oxidase method. The study group mean age was 51 ±14 as against control group of 47 ± 10. One hundred and fifty subjects were divided in two groups based on serum glucose concentration. Group A (control group) consisted of 50 subjects with mean serum glucose concentration 4.3 ±1.7 mmol/l and anion gap 13.8 ± 2.6, group B (diabetics) consisted of 100 subjects that had serum glucose concentration 15.0 ± 3.9 and anion gap 18.4 ± 2.5. The glucose was estimation by glucose oxidase method, whereas the anion gap was calculated by subtracting the concentrations of sodium and potassium from the concentrations of chloride and bicarbonate. The concentrations of the electrolytes where assayed using ion selective electrodes (ISE). A statistical significant difference P was observed between group A and B glucose concentrations and the anion gap. The abnormal anion gap was created by the insufficiency of bicarbonate used for the buffering of the electrolytes variability occasioned by derangement in glucose metabolism and distorted hormonal secretion. Hence metabolic acidosis is strongly linked with diabetics as a result of distorted anion gap. Healthcare providers and takers should ensure that anion gap estimation is factored into investigations for the management of diabetics. Also, patients with deranged anion gap should be placed as an emergency case for proper management. Clinicians should ensure that patient’s anion gap is within the reference anion gap range so as to prevent development into metabolic acidosis and subsequent ketoacidosis.展开更多
目的 探讨白蛋白校正阴离子间隙(albumin corrected anion gap,ACAG)值的高低与心源性休克(cardiogenic shock,CS)患者预后的关系。方法 回顾性分析2001年6月至2012年10月美国重症监护数据库Ⅲ(Medical Information Mart for Intensive ...目的 探讨白蛋白校正阴离子间隙(albumin corrected anion gap,ACAG)值的高低与心源性休克(cardiogenic shock,CS)患者预后的关系。方法 回顾性分析2001年6月至2012年10月美国重症监护数据库Ⅲ(Medical Information Mart for Intensive CareⅢ,MIMIC-Ⅲ)中在重症监护室(intensive care unit,ICU)住院的成人CS患者528例。根据住院期间(≤30d)预后情况将其分为存活组(n=316)和死亡组(n=212),比较两组性别、年龄、住院期间临床结局等临床资料。根据ACAG水平将患者分为正常ACAG组(12~20mmol/L,n=289)和高ACAG组(>20mmol/L,n=239),采用Kaplan-Meier生存曲线和log-rank检验评价生存风险,采用Cox比例风险回归模型评价危险因素。结果 与存活组相比,死亡组的年龄、序贯器官衰竭评分(sequential organ failure assessment,SOFA评分)、阴离子间隙(anion gap,AG)、红细胞分布宽度(red blood cell distribution width,RDW)、肌酐、国际标准化比值(international normalized ratio,INR)更高,白蛋白值更低,合并心脏骤停及慢性阻塞性肺疾病者更多,ACAG值更高,总体住院时间更短(P<0.05)。Kaplan-Meier生存曲线结果显示,高ACAG组CS患者30d累积生存率显著低于正常ACAG组(log-rank χ2=15.120,P<0.05)。多因素Cox比例风险回归分析结果表明高ACAG是影响ICU的CS患者住院期间全因死亡率的独立危险因素[(风险比(hazard ratio,HR)=1.444,95%置信区间(confidence interval,CI):1.077~1.935,P<0.05]。结论 ICU住院患者中,ACAG增高是CS患者住院期间(≤30d)全因死亡率的独立危险因素,在临床工作可利用其早期预警作用帮助临床医生进行适时干预,从而达到降低CS患者死亡率的目的。展开更多
基金Acknowledgement This work was supported by the Beijing Nova Program （No. Z121107002512053）, the Beijing Health System High Level Health Technology Talent Cultivation Plan （No. 2013-3-013）, the Beijing Outstanding Talent Training Program （No. 2014000021223ZK32）, and the National Natural Science Foundation of China （No. 81100143） to S.W.Y., and the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support （No. ZYLX201303） to Y.J.Z.
文摘Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.
文摘Diabetes mellitus is the most common metabolic disorder occasioned by derangement in glucose equilibration between the ECF and ICF. The derangement is known to affect the appropriate balance of electrolytes that serves as a buffer in the body. In this study anion gap was evaluated among outpatient diabetics as compared to non-diabetics control group. The categorization into the study or control groups was done by serum glucose estimation using glucose oxidase method. The study group mean age was 51 ±14 as against control group of 47 ± 10. One hundred and fifty subjects were divided in two groups based on serum glucose concentration. Group A (control group) consisted of 50 subjects with mean serum glucose concentration 4.3 ±1.7 mmol/l and anion gap 13.8 ± 2.6, group B (diabetics) consisted of 100 subjects that had serum glucose concentration 15.0 ± 3.9 and anion gap 18.4 ± 2.5. The glucose was estimation by glucose oxidase method, whereas the anion gap was calculated by subtracting the concentrations of sodium and potassium from the concentrations of chloride and bicarbonate. The concentrations of the electrolytes where assayed using ion selective electrodes (ISE). A statistical significant difference P was observed between group A and B glucose concentrations and the anion gap. The abnormal anion gap was created by the insufficiency of bicarbonate used for the buffering of the electrolytes variability occasioned by derangement in glucose metabolism and distorted hormonal secretion. Hence metabolic acidosis is strongly linked with diabetics as a result of distorted anion gap. Healthcare providers and takers should ensure that anion gap estimation is factored into investigations for the management of diabetics. Also, patients with deranged anion gap should be placed as an emergency case for proper management. Clinicians should ensure that patient’s anion gap is within the reference anion gap range so as to prevent development into metabolic acidosis and subsequent ketoacidosis.
文摘目的 探讨白蛋白校正阴离子间隙(albumin corrected anion gap,ACAG)值的高低与心源性休克(cardiogenic shock,CS)患者预后的关系。方法 回顾性分析2001年6月至2012年10月美国重症监护数据库Ⅲ(Medical Information Mart for Intensive CareⅢ,MIMIC-Ⅲ)中在重症监护室(intensive care unit,ICU)住院的成人CS患者528例。根据住院期间(≤30d)预后情况将其分为存活组(n=316)和死亡组(n=212),比较两组性别、年龄、住院期间临床结局等临床资料。根据ACAG水平将患者分为正常ACAG组(12~20mmol/L,n=289)和高ACAG组(>20mmol/L,n=239),采用Kaplan-Meier生存曲线和log-rank检验评价生存风险,采用Cox比例风险回归模型评价危险因素。结果 与存活组相比,死亡组的年龄、序贯器官衰竭评分(sequential organ failure assessment,SOFA评分)、阴离子间隙(anion gap,AG)、红细胞分布宽度(red blood cell distribution width,RDW)、肌酐、国际标准化比值(international normalized ratio,INR)更高,白蛋白值更低,合并心脏骤停及慢性阻塞性肺疾病者更多,ACAG值更高,总体住院时间更短(P<0.05)。Kaplan-Meier生存曲线结果显示,高ACAG组CS患者30d累积生存率显著低于正常ACAG组(log-rank χ2=15.120,P<0.05)。多因素Cox比例风险回归分析结果表明高ACAG是影响ICU的CS患者住院期间全因死亡率的独立危险因素[(风险比(hazard ratio,HR)=1.444,95%置信区间(confidence interval,CI):1.077~1.935,P<0.05]。结论 ICU住院患者中,ACAG增高是CS患者住院期间(≤30d)全因死亡率的独立危险因素,在临床工作可利用其早期预警作用帮助临床医生进行适时干预,从而达到降低CS患者死亡率的目的。
