Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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The Significance of the Strong Ion Gap in Predicting Acute Kidney Injury and In-hospital Mortality in Critically Ill Patients with Acute Poisoning

중증 급성 중독 환자에서 급성 신장 손상과 병원 내 사망률을 예측하기 위한 강이온차(Strong Ion Gap)의 중요성

  • Sim, Tae Jin (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Cho, Jae Wan (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Mi Jin (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Jung, Haewon (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jungbae (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Seo, Kang Suk (Department of Emergency Medicine, School of Medicine, Kyungpook National University)
  • 심태진 (경북대학교 의과대학 응급의학교실) ;
  • 조재완 (경북대학교 의과대학 응급의학교실) ;
  • 이미진 (경북대학교 의과대학 응급의학교실) ;
  • 정해원 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실)
  • Received : 2021.06.01
  • Accepted : 2021.09.08
  • Published : 2021.12.31
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Abstract

Purpose: A high anion gap (AG) is known to be a significant risk factor for serious acid-base imbalances and death in acute poisoning cases. The strong ion difference (SID), or strong ion gap (SIG), has recently been used to predict in-hospital mortality or acute kidney injury (AKI) in patients with systemic inflammatory response syndrome. This study presents a comprehensive acid-base analysis in order to identify the predictive value of the SIG for disease severity in severe poisoning. Methods: A cross-sectional observational study was conducted on acute poisoning patients treated in the emergency intensive care unit (ICU) between December 2015 and November 2020. Initial serum electrolytes, base deficit (BD), AG, SIG, and laboratory parameters were concurrently measured upon hospital arrival and were subsequently used along with Stewart's approach to acid-base analysis to predict AKI development and in-hospital death. The area under the receiver operating characteristic curve (AUC) and logistic regression analysis were used as statistical tests. Results: Overall, 343 patients who were treated in the intensive care unit were enrolled. The initial levels of lactate, AG, and BD were significantly higher in the AKI group (n=62). Both effective SID [SIDe] (20.3 vs. 26.4 mEq/L, p<0.001) and SIG (20.2 vs. 16.5 mEq/L, p<0.001) were significantly higher in the AKI group; however, the AUC of serum SIDe was 0.842 (95% confidence interval [CI]=0.799-0.879). Serum SIDe had a higher predictive capacity for AKI than initial creatinine (AUC=0.796, 95% CI=0.749-0.837), BD (AUC=0.761, 95% CI=0.712-0.805), and AG (AUC=0.660, 95% CI=0.607-0.711). Multivariate logistic regression analyses revealed that diabetes, lactic acidosis, high SIG, and low SIDe were significant risk factors for in-hospital mortality. Conclusion: Initial SIDe and SIG were identified as useful predictors of AKI and in-hospital mortality in intoxicated patients who were critically ill. Further research is necessary to evaluate the physiological nature of the toxicant or unmeasured anions in such patients.

Keywords

References

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