Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation
Background/Aim. Acid-base disorders are common within critically ill patients. Physicochemical approach described by Stewart and modified by Figge gives precise quantification method of metabolic acidosis and insight into its main mechanisms, as well as influence of unmeasured anion on m...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2014-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501410936N.pdf |
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| author | Novović Miloš N. Jevđić Jasna |
| author_facet | Novović Miloš N. Jevđić Jasna |
| author_sort | Novović Miloš N. |
| collection | DOAJ |
| description | Background/Aim. Acid-base disorders are common within critically ill
patients. Physicochemical approach described by Stewart and modified by
Figge gives precise quantification method of metabolic acidosis and insight
into its main mechanisms, as well as influence of unmeasured anion on
metabolic acidosis. The aims of this study were to determine whether the
conventional acid-base variables are connected with survival rate of
critically ill patients at Intensive care unit; whether strong ion
difference/strong ion gap (SID/SIG) is a better predictor of mortality rate
comparing to conventional acid-base variables; to determine all significant
predictable parameters for the 28-day mortality rate at intensive care
units. Methods. This retrospective observational analytic study included 142
adult patients requiring mechanical ventilation, survivors (n = 68) and
nonsurvivors (n = 74). Apparent strong ion difference (SIDapp), effective
strong ion difference (SIDeff) and SIG values were calculated with the
Stewart-Figge’s quantitative biophysical method. Descriptive and analytical
statistical methods were used in the study [t-test, Mann-Whitney U test,
χ2-test, binary logistic regression, Reciever operating characteristic
(ROC) curves, calibration]. Results. Age, Na+, acute physiology and chronic
health evaluation (APACHE II), Cl-, albumin, SIG, SID app, SIDeff, and
aninon gap (AG) were statistically significant predictors. AG represented a
model with imprecise calibration, i.e. a model with little predictive power.
APACHE II had p-value more than 0.05 if it was near it, and therefore it
could be considered potentially unreliable for outcome prediction. SIDeff
and SIG represented models with well-defined calibration. ROC analysis
results showed that APACHE II, Cl-, albumin, SIDeff, SIG i AG had the
largest area bellow the curve. By creation of logistic models with
calibration methods, we found that outcome depends on SIG and APACHE II
score. Conclusion. Based on our data, unmeasured anions provide prediction
of mortality of critically ill patients on mechanical ventilation, unlike
the traditional acid-base variables which are not accurate predictors of the
28-day mortality rate. |
| format | Article |
| id | doaj-art-7c43e61362a84e43a35b70e5fb6fc6fd |
| institution | DOAJ |
| issn | 0042-8450 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-7c43e61362a84e43a35b70e5fb6fc6fd2025-08-20T03:06:53ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502014-01-01711093694110.2298/VSP1410936N0042-84501410936NPrediction of mortality with unmeasured anions in critically ill patients on mechanical ventilationNovović Miloš N.0Jevđić Jasna1General Hospital, Anesthesiology and Reanimation Department, PrijepoljeClinical Center Kragujevac, Anesthesiology and Reanimation Center, KragujevacBackground/Aim. Acid-base disorders are common within critically ill patients. Physicochemical approach described by Stewart and modified by Figge gives precise quantification method of metabolic acidosis and insight into its main mechanisms, as well as influence of unmeasured anion on metabolic acidosis. The aims of this study were to determine whether the conventional acid-base variables are connected with survival rate of critically ill patients at Intensive care unit; whether strong ion difference/strong ion gap (SID/SIG) is a better predictor of mortality rate comparing to conventional acid-base variables; to determine all significant predictable parameters for the 28-day mortality rate at intensive care units. Methods. This retrospective observational analytic study included 142 adult patients requiring mechanical ventilation, survivors (n = 68) and nonsurvivors (n = 74). Apparent strong ion difference (SIDapp), effective strong ion difference (SIDeff) and SIG values were calculated with the Stewart-Figge’s quantitative biophysical method. Descriptive and analytical statistical methods were used in the study [t-test, Mann-Whitney U test, χ2-test, binary logistic regression, Reciever operating characteristic (ROC) curves, calibration]. Results. Age, Na+, acute physiology and chronic health evaluation (APACHE II), Cl-, albumin, SIG, SID app, SIDeff, and aninon gap (AG) were statistically significant predictors. AG represented a model with imprecise calibration, i.e. a model with little predictive power. APACHE II had p-value more than 0.05 if it was near it, and therefore it could be considered potentially unreliable for outcome prediction. SIDeff and SIG represented models with well-defined calibration. ROC analysis results showed that APACHE II, Cl-, albumin, SIDeff, SIG i AG had the largest area bellow the curve. By creation of logistic models with calibration methods, we found that outcome depends on SIG and APACHE II score. Conclusion. Based on our data, unmeasured anions provide prediction of mortality of critically ill patients on mechanical ventilation, unlike the traditional acid-base variables which are not accurate predictors of the 28-day mortality rate.http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501410936N.pdfcritical illnessacid-base imbalanceintensive care unitsmortality |
| spellingShingle | Novović Miloš N. Jevđić Jasna Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation Vojnosanitetski Pregled critical illness acid-base imbalance intensive care units mortality |
| title | Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| title_full | Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| title_fullStr | Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| title_full_unstemmed | Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| title_short | Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| title_sort | prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation |
| topic | critical illness acid-base imbalance intensive care units mortality |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501410936N.pdf |
| work_keys_str_mv | AT novovicmilosn predictionofmortalitywithunmeasuredanionsincriticallyillpatientsonmechanicalventilation AT jevđicjasna predictionofmortalitywithunmeasuredanionsincriticallyillpatientsonmechanicalventilation |