ArticleJournal of intensive care2016
A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study.
Article in Journal of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 47 citations in OpenAlex.
- The Prognostic Value of Cardiac Biomarkers in Combination with the SOFA Score for the Evaluation of Sepsis-Related Mortality.Medicina (Kaunas, Lithuania) · 2026Article
- Unveiling the Gaps: Machine Learning Models for Unmeasured Ions.Diagnostics (Basel, Switzerland) · 2026Article
- Prognostic value of serial alactic base excess measurements in patients with sepsis: a retrospective cohort study.Frontiers in medicine · 2026Article
- Association between sodium-chloride difference at ICU admission and 30-day mortality: a retrospective cohort study of critically ill adults.BMC anesthesiology · 2025Article
- Prognostic Significance of the Strong Ion Gap in Patients in Medical and Surgical Intensive Care Units.Cureus · 2023Article
- Insights into Hemodynamic Features of Survivors and the Deceased with Acute Brain Injury: A Step Forward Tailored Treatment.Journal of clinical medicine · 2023Article
- Metabolic alkalosis and mixed acid-base disturbance in anaesthesia and critical care.BJA education · 2023Review
- Admission Lactate Concentration, Base Excess, and Alactic Base Excess Predict the 28-Day Inward Mortality in Shock Patients.Journal of clinical medicine · 2022Article
- Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study.BMC surgery · 2022Article
- The Effect of the Non-compressed Oxygen Therapy and Hyperbaric Oxygenation in Combination With Standardized Drug Therapy on the Blood Acid-Base State Biomarkers in Alcohol Withdrawal Syndrome, an Experimental Study.Frontiers in psychiatry · 2022Article
- Article
- Association Between Anion Gap and Mortality in Critically Ill Patients with Cardiogenic Shock.International journal of general medicine · 2021Article
- Association of Chloride Ion and Sodium-Chloride Difference With Acute Kidney Injury and Mortality in Critically Ill Patients.Critical care explorations · 2020Article
- Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury.Journal of clinical and translational hepatology · 2019Article
- Can base excess and anion gap predict lactate level in diagnosis of septic shock?Open access emergency medicine : OAEM · 2018Article
- Traditional approach versus Stewart approach for acid-base disorders: Inconsistent evidence.SAGE open medicine · 2018Review
- Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals.Journal of veterinary internal medicine · 2017Review
- Effect of non-linearity of a predictor on the shape and magnitude of its receiver-operating-characteristic curve in predicting a binary outcome.Scientific reports · 2017Article
- Unmeasured anions and mortality in critically ill patients in 2016.Journal of intensive care · 2016Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundThis cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill.
methodsThe relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC).
resultsOf the 6878 patients included in the study, 924 patients (13.4 %) died after ICU admission. Except for plasma chloride concentrations, all acid-base markers were significantly different between the survivors and non-survivors. SIG (with lactate: AUROC 0.631, confidence interval [CI] 0.611-0.652; without lactate: AUROC 0.521, 95 % CI 0.500-0.542) only had a modest ability to predict hospital mortality, and this was no better than using lactate concentration alone (AUROC 0.701, 95 % 0.682-0.721). Adding AG-corrected or SIG to a combination of lactate and MPM0 III predicted risks also did not substantially improve the latter's ability to differentiate between survivors and non-survivors. Arterial lactate concentrations explained about 11 % of the variability in the observed mortality, and it was more important than SIG (0.6 %) and SIDe (0.9 %) in predicting hospital mortality after adjusting for MPM0 III predicted risks. Lactate remained as the strongest predictor for mortality in a sensitivity multivariate analysis, allowing for non-linearity of all acid-base markers.
conclusionsThe prognostic significance of SIG was modest and inferior to arterial lactate concentration for the critically ill. Lactate concentration should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.
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