Jinhua Zhu, Zeying Zhang, Yefei Lei, Zhenrong Ouyang, Shelby Kutty, Qiming Liu, Yunbin Xiao
First People’s Hospital of Chenzhou and Hunan Children’s Hospital Affiliated to Jinan University. Xiamen Cardiovascular Hospital of Xiamen University. Johns Hopkins School of Medicine. Second Xiangya Hospital and Affiliated Children’s Hospital of Central South University.
China
Frontiers in Medicine
Front Med 2025; 11:
DOI: 10.3389/fmed.2024.1499677
Abstract
Background: The relationship between anion gap (AG) and short-term mortality of pulmonary hypertension (PH) patients with sepsis in the intensive care unit (ICU) remains unclear.
Methods: This study involved a retrospective analysis of incident PH patients with sepsis first admitted to the ICU in the MIMIC IV database (2008 to 2019). Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high-AG and low-AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in PH patients with sepsis.
Results: A total of 2,012 sepsis patients with PH were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high-AG group were higher than those in the low-AG group (5.0% or 7.2%, respectively; P < 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high-AG group than in the low-AG group (P < 0.001). The multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, and length of stay in the ICU and hospital. The relationship between elevated AG and in-hospital mortality remains stable after subgroup analyses.
Conclusion: Elevated serum AG is associated with increased risk-adjusted short-term mortality in PH patients with sepsis, and it may aid clinicians in identifying patients with poor prognosis as early as possible.
Category
Class I. Pulmonary Hypertension Associated with Infection
Acquired Patient Factors Associated with Pulmonary Vascular Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Diagnostic Testing for Pulmonary Vascular Disease. Risk Stratification
Age Focus: Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes