Background
Methods
Data retrieval
Clinical outcome
Data analysis
Results
Enrollment
Baseline data
Variables | ICU-Survival (N = 377) | ICU-Death (N = 28) | P value | |
---|---|---|---|---|
General condition | ||||
Admission type | < 0.001 | |||
ELECTIVE | 282 (74.8%) | 8 (28.6%) | ||
EMERGENCY | 86 (22.8%) | 20 (71.4%) | ||
URGENT | 9 (2.4%) | 0 (0.0%) | ||
Death in hospital | 2 (0.5%) | 28 (100.0%) | < 0.001 | |
Death within 90 days | 8 (2.1%) | 28 (100.0%) | < 0.001 | |
Death within 365 days | 20 (5.3%) | 28 (100.0%) | < 0.001 | |
LOS in hospital (days) | 9.06 [6.27, 14.15] | 12.00 [4.07, 19.01] | < 0.001 | |
LOS in intensive care unit (days) | 3.08 [1.86, 6.81] | 11.88 [2.65, 19.19] | 0.782 | |
Age (years) | 68.58 [59.14, 75.40] | 76.80 [70.14, 80.96] | < 0.001 | |
Type of aortic aneurysm | < 0.001 | |||
Abdominal aneurysm without mention of rupture | 101 (26.8%) | 8 (28.6%) | ||
Abdominal aneurysm, ruptured | 25 (6.6%) | 10 (35.7%) | ||
Thoracic aneurysm without mention of rupture | 216 (57.3%) | 5 (17.9%) | ||
Thoracic aneurysm, ruptured | 5 (1.3%) | 1 (3.6%) | ||
Thoracoabdominal aneurysm, ruptured | 5 (1.3%) | 2 (7.1%) | ||
Thoracoabdominal aneurysm, without mention of rupture | 25 (6.6%) | 2 (7.1%) | ||
Male | 248 (65.8%) | 13 (46.4%) | 0.063 | |
Aortic rupture | 35 (9.3%) | 13 (46.4%) | < 0.001 | |
Comorbidity | ||||
Sepsis | 6 (1.6%) | 6 (21.4%) | < 0.001 | |
Chronic pulmonary diseases | 81 (21.5%) | 7 (25.0%) | 0.843 | |
Peripheral vascular diseases | 198 (52.5%) | 9 (32.1%) | 0.059 | |
hypertension | 22 (5.8%) | 3 (10.7%) | 0.53 | |
Renal failure | 27 (7.2%) | 4 (14.3%) | 0.318 | |
Coagulopathy | 66 (17.5%) | 11 (39.3%) | 0.01 | |
Fluid and electrolyte disorders | 82 (21.8%) | 7 (25.0%) | 0.87 | |
Laboratory indicators on admission | ||||
Anion gap (mEq/L) | 12.00 [11.00, 14.00] | 17.00 [15.75, 22.00] | < 0.001 | |
Bicarbonate (mEq/L) | 23.00 [21.00, 25.00] | 17.50 [15.75, 21.00] | < 0.001 | |
Creatinine (mg/dL) | 1.00 [0.80, 1.20] | 1.65 [1.15, 2.10] | < 0.001 | |
Blood urea nitrogen (mg/dL) | 17.00 [13.00, 21.00] | 27.00 [20.75, 34.25] | < 0.001 | |
Hematocrit (%) | 25.00 [21.10, 29.00] | 24.65 [21.00, 26.10] | 0.266 | |
Hemoglobin (g/dL) | 8.50 [7.40, 9.80] | 8.35 [7.00, 8.80] | 0.106 | |
PTT (sec) | 41.45 [34.35, 51.55] | 76.45 [43.55, 122.25] | < 0.001 | |
PT (sec) | 15.80 [14.60, 17.50] | 17.55 [14.75, 19.40] | 0.074 | |
INR | 1.50 [1.30, 1.70] | 1.80 [1.37, 2.32] | 0.026 | |
white blood cell count (K/μL) | 12.50 [9.90, 15.70] | 14.65 [10.38, 16.95] | 0.048 | |
Platelet count (K/μL) | 124.00 [89.75, 156.00] | 84.50 [61.00, 120.00] | < 0.001 | |
Treatment | ||||
Extracorporeal circulation | 243 (64.5%) | 7 (25.0%) | < 0.001 | |
Bypass surgery | 14 (3.7%) | 2 (7.1%) | 0.692 | |
Ventilation in first day | 356 (94.4%) | 26 (92.9%) | 1 | |
Urine output on first day (ml) | 2026.00 [1393.50, 3038.75] | 948.00 [344.00, 1428.00] | < 0.001 | |
Severity scores | ||||
GCS | 15.00 [14.25, 15.00] | 15.00 [15.00, 15.00] | 0.133 | |
SOFA | 5.00 [4.00, 8.00] | 9.00 [7.75, 11.25] | < 0.001 | |
SAPSII | 32.00 [26.00, 42.00] | 49.50 [43.75, 65.00] | < 0.001 |
Risk stratification
Variables | Anion gap < 12 mEq/L (N = 151) | Anion gap between 12–16 mEq/L (N = 200) | Anion gap > 16 m Eq/L (N = 54) | P value | |
---|---|---|---|---|---|
General condition | |||||
Admission type | < 0.001 | ||||
ELECTIVE | 121 (80.1%) | 153 (76.5%) | 16 (29.6%) | ||
EMERGENCY | 27 (17.9%) | 42 (21.0%) | 37 (68.5%) | ||
URGENT | 3 (2.0%) | 5 (2.5%) | 1 (1.9%) | ||
Death in ICU | 1 (0.7%) | 8 (4.0%) | 19 (35.2%) | < 0.001 | |
Death in hospital | 2 (1.3%) | 8 (4.0%) | 20 (37.0%) | < 0.001 | |
Death within 90 days | 4 (2.6%) | 11 (5.5%) | 21 (38.9%) | < 0.001 | |
Death within 365 days | 6 (4.0%) | 15 (7.5%) | 27 (50.0%) | < 0.001 | |
LOS in hospital (days) | 7.36 [6.12, 11.01] | 9.24 [6.27, 16.87] | 13.52 [9.26, 21.77] | < 0.001 | |
LOS in ICU (days,) | 2.25 [1.33, 3.98] | 3.39 [2.01, 9.18] | 8.95 [3.01, 20.01] | < 0.001 | |
Type of aortic aneurysm | < 0.001 | ||||
Abdominal aneurysm without mention of rupture | 34 (22.5%) | 63 (31.5%) | 12 (22.2%) | ||
Abdominal aneurysm, ruptured | 2 (1.3%) | 12 (6.0%) | 21 (38.9%) | ||
Thoracic aneurysm without mention of rupture | 105 (69.5%) | 109 (54.5%) | 7 (13.0%) | ||
Thoracic aneurysm, ruptured | 1 (0.7%) | 1 (0.5%) | 4 (7.4%) | ||
Thoracoabdominal aneurysm, ruptured | 2 (1.3%) | 2 (1.0%) | 3 (5.6%) | ||
Thoracoabdominal aneurysm, without mention of rupture | 7 (4.6%) | 13 (6.5%) | 7 (13.0%) | ||
Age (years) | 64.04 [56.20, 73.00] | 70.35 [60.43, 76.72] | 73.06 [69.39, 79.86] | < 0.001 | |
Male | 95 (62.9%) | 140
(70.0%) | 26 (48.1%) | 0.011 | |
Aortic rupture | 5 (3.3%) | 15 (7.5%) | 28 (51.9%) | < 0.001 | |
Comorbidity | |||||
Sepsis | 2 (1.3%) | 4 (2.0%) | 6 (11.1%) | 0.001 | |
Chronic pulmonary diseases | 31 (20.5%) | 48 (24.0%) | 9 (16.7%) | 0.461 | |
Peripheral vascular diseases | 90 (59.6%) | 99 (49.5%) | 18 (33.3%) | 0.003 | |
hypertension | 7 (4.6%) | 13 (6.5%) | 5 (9.3%) | 0.463 | |
Renal failure | 7 (4.6%) | 17 (8.5%) | 7 (13.0%) | 0.116 | |
Coagulopathy | 19 (12.6%) | 35 (17.5%) | 23 (42.6%) | < 0.001 | |
Fluid and electrolyte disorders | 29 (19.2%) | 43 (21.5%) | 17 (31.5%) | 0.17 | |
Laboratory indicators on admission | |||||
Anion gap (mEq/L) | 10.00 [9.00, 11.00] | 13.00 [12.00, 14.00] | 19.00 [17.00, 22.00] | < 0.001 | |
Bicarbonate (mEq/L) | 24.00 [22.00, 25.00] | 23.00 [20.75, 24.00] | 18.00 [16.00, 21.75] | < 0.001 | |
Creatinine (mg/dL) | 0.80 [0.70, 1.10] | 1.00 [0.80, 1.33] | 1.50 [1.12, 2.08] | < 0.001 | |
Blood urea nitrogen (mg/dL) | 15.00 [13.00, 18.00] | 18.00 [14.00, 23.25] | 24.00 [18.00, 28.00] | < 0.001 | |
Hematocrit (%) | 24.60 [21.10, 27.00] | 25.00 [21.48, 29.00] | 25.60 [21.00, 27.60] | 0.613 | |
Hemoglobin (g/dL) | 8.40 [7.50, 9.65] | 8.50 [7.30, 9.90] | 8.50 [7.10, 9.57] | 0.69 | |
PTT (sec) | 40.70 [35.95, 50.80] | 41.25 [33.45, 50.05] | 62.05 [39.00, 130.43] | < 0.001 | |
PT (sec) | 15.90 [14.85, 17.30] | 15.50 [14.30, 17.12] | 17.00 [14.83, 19.67] | 0.007 | |
INR | 1.50 [1.30, 1.70] | 1.40 [1.30, 1.70] | 1.80 [1.33, 2.30] | 0.001 | |
white blood cell count (K/μL) | 12.70 [9.90, 15.30] | 12.60 [10.20, 16.00] | 12.00 [9.43, 16.18] | 0.817 | |
Platelet count (K/μL) | 124.00 [97.00, 151.50] | 125.00 [89.00, 157.00] | 93.50 [58.25, 141.75] | 0.001 | |
Treatment | |||||
Extracorporeal circulation | 120 (79.5%) | 115 (57.5%) | 15 (27.8%) | < 0.001 | |
Bypass surgery | 6 (4.0%) | 7 (3.5%) | 3 (5.6%) | 0.789 | |
Ventilation in first
day | 147 (97.4%) | 186 (93.0%) | 49 (90.7%) | 0.104 | |
Urine output in first day (ml) | 2205.00 [1723.50, 3217.00] | 1982.50 [1268.50, 3012.50] | 1006.50 [489.50, 1968.50] | < 0.001 | |
Severity scores | |||||
GCS | 15.00 [14.00, 15.00] | 15.00 [14.75, 15.00] | 15.00 [15.00, 15.00] | 0.115 | |
SOFA | 5.00 [3.00, 7.00] | 5.00 [4.00, 8.00] | 8.00 [5.25, 10.00] | < 0.001 | |
SAPSII | 31.00 [26.00, 38.50] | 32.50 [27.00, 42.00] | 46.50 [40.00, 58.50] | < 0.001 |
Outcome | Continuous AG | SAPSII | |||||
---|---|---|---|---|---|---|---|
AUC (95% CI) | AUC (95% CI) | P valuea | NRI (95% CI) | P valueb | IDI (95%) | P valuec | |
In-ICU mortality | 0.882(0.818–0.946) | 0.839(0.771–0.908) | 0.215 | 0.302(-0.074–0.677) | 0.115 | 0.118(-0.013–0.249) | 0.077 |
In-Hospital mortality | 0.861(0.785–0.937) | 0.833(0.767–0.899) | 0.441 | 0.373(0.009–0.738) | 0.045 | 0.110(-0.011–0.232) | 0.076 |
90-day mortality | 0.809(0.722–0.895) | 0.801(0.730–0.872) | 0.847 | 0.176(-0.158–0.511) | 0.302 | 0.082(-0.014–0.179) | 0.095 |
1-year mortality | 0.775(0.700–0.850) | 0.780(0.714–0.845) | 0.878 | 0.304(0.007–0.601) | 0.045 | 0.095(0.022–0.167) | 0.01 |
Relationship between AG and mortality
Subgroup analysis
Multivariate logistic regression
AG | OR (95% CI) | P value |
---|---|---|
Crude | 1.423(1.285–1.598) | < 0.001 |
Model I | 1.199(1.063–1.380) | 0.006 |
Model II | 1.379(1.209–1.611) | < 0.001 |
Model III | 1.316(1.142–1.546) | < 0.001 |
Model IV | 1.286(1.053–1.651) | 0.025 |