Journal
INTENSIVE CARE MEDICINE
Volume 28, Issue 7, Pages 864-869Publisher
SPRINGER
DOI: 10.1007/s00134-002-1318-2
Keywords
strong ion gap; standard base excess; prognostic indicators; acid-base disturbance
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Objective: To examine whether the strong ion gap (SIG) or standard base excess corrected for abnormalities of serum chloride and albumin (BEUA) can predict outcome and to compare the prognostic abilities of these variables with standard base excess (SBE), anion gap (AG), pH, and lactate, the more traditional markers of acid-base disturbance. Design: Prospective, observational study. Setting: University teaching hospital, general adult ICU. Patients: One hundred consecutive patients on admission to the ICU. Measurements and results: The anion gap (AG) was calculated and corrected for abnormal serum albumin (AG(corrected)). Serum lactate was measured and SBE, BEUA, SIG, and APACHE 11 scores calculated for each patient. 28-day survival was recorded. There was a significant difference between the mean APACHE 11 (P<0.001), SBE (P<0.001), lactate (P=0.008), AG (P=0.007), pH (P<0.001), and BEUA (P=0.009) of survivors and non-survivors. There was no significant difference between the mean SIG (P=0.088), SIDeff (P=0.025), and SID app (P=0.254) between survivors and non-survivors. The pH and SBE demonstrated the best ability of the acid-base variables to predict outcome (AUROC curves 0.72 and 0.71, respectively). Neither of these were as good as the APACHE 11 score (AUROC 0.76) Conclusion: Traditional indices of SBE, BEUA, lactate, pH, AG, and APACHE 11 all discriminated well between survivors and non-survivors. In this group of patients the SIG, SIDeff, and SIGapp appear to offer no advantage in prediction of outcome and their use as prognostic markers can therefore not be advocated.
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