Longsheng Zhang, Shujun Ye, Jinyu Hu, Zhiliang Huang, Xulin Lin, Yingshan Lin, Renzhe Lin, Huankai Zhang, Duo Yang
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引用次数: 0
Abstract
Background: The purpose of this study was to identify distinct trajectories of the anion gap (AG) of patients with sepsis within the first 48 h following intensive care unit (ICU) admission and to explore the relationship between these trajectories and all-cause mortality.
Methods: This study was carried out involving patients with sepsis from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Group-based trajectory modeling (GBTM) was utilized to identify the distinct trajectory groups for the AG values. The primary outcome was 30-day mortality, and the secondary outcomes were 90-day and 1-year mortality. Both univariable and multivariable Cox proportional hazards regression models were performed to explore the relationship between different AG longitudinal trajectories and mortality. Stratified analyses were performed to investigate the stability of the relationship between AG trajectories and the primary outcome.
Results: A total of 6960 patients with sepsis were included for trajectory grouping. Four distinct AG trajectories based on the model fitting standard were identified: group 1 (11.19%), group 2 (52.87%), group 3 (29.86%), and group 4 (6.08%). Using trajectory group 1 as the reference, after adjusting for all potential confounders, group 2, group 3, and group 4 still had 1.32 (95% confidence interval [CI] 1.07-1.63), 1.67 (95% CI 1.33-2.09), and 1.87 (95% CI 1.40-2.51) times the risk of 30-day mortality, respectively. Similar results were also found for 90-day mortality and 1-year mortality. The associations were directionally similar across all subgroups.
Conclusions: Trajectory groups with higher AG levels were associated with an increased risk for all-cause mortality. Identifying distinct AG trajectories may help identify patient subgroups with varying risks of mortality, providing valuable implications for both research and clinical practice.
背景：本研究的目的是确定脓毒症患者在重症监护病房（ICU）入院后最初48小时内阴离子间隙（AG）的不同轨迹，并探讨这些轨迹与全因死亡率之间的关系。方法：本研究纳入重症监护医学信息市场IV （MIMIC-IV）数据库中的脓毒症患者。采用基于组的轨迹模型（GBTM）识别不同轨迹组的AG值。主要结局为30天死亡率，次要结局为90天和1年死亡率。采用单变量和多变量Cox比例风险回归模型，探讨不同AG纵向轨迹与死亡率之间的关系。我们进行了分层分析，以调查ags轨迹与主要结局之间关系的稳定性。结果：共纳入6960例脓毒症患者进行轨迹分组。根据模型拟合标准，确定了4种不同的AG轨迹：1组（11.19%）、2组（52.87%）、3组（29.86%）和4组（6.08%）。以轨迹组1为参考，在调整所有潜在混杂因素后，组2、组3和组4的30天死亡率风险分别为1.32（95%置信区间[CI] 1.07-1.63）、1.67 （95% CI 1.33-2.09）和1.87 （95% CI 1.40-2.51）倍。在90天死亡率和1年死亡率中也发现了类似的结果。所有亚组的关联方向相似。结论：血清抗原水平较高的轨迹组与全因死亡风险增加相关。确定不同的AG轨迹可能有助于确定具有不同死亡风险的患者亚组，为研究和临床实践提供有价值的意义。
期刊介绍：
European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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