血清白蛋白校正阴离子间隙对重症非ST段抬高急性心肌梗死患者长期预后的评估价值OACSTPCD

Objective To investigate the predictive value of serum albumin-corrected anion gap(ACAG)for long-term prognosis in critically ill patients with non-ST-segment elevation acute myocardial infarction(NSTEMI).Methods A retrospective analysis was conducted on the clinical data collected from 513 adult patients with NSTEMI hospitalized in the intensive care unit(ICU)from 2008 to 2019,using the Medical Information Mart for Intensive Care(MIMIC-IV,version 2.0).According to the 360-day prognosis,patients were divided into the survival group(287 cases)and the death group(226 cases).Patients were further divided into the normal ACAG group(249 cases)and the high ACAG group(264 cases)based on the ACAG level at ICU admission.Kaplan-Meier method was used to plot cumulative survival curves at 360 days,and Cox regression analysis was applied to assess the predictive value of ACAG at ICU admission for the 360-day all-cause mortality in severe NSTEMI patients.Results Compared to the survival group,age,Sequential Organ Failure Assessment(SOFA)score,acute physiology score Ⅲ,Charlson comorbidity index,anion gap,ACAG,blood urea nitrogen,creatinine,international normalized ratio,blood glucose,blood phosphorus,proportion of cardiac arrest,and length of ICU stay in the death group were higher,the differences were statistically significant(all P＜0.05).Kaplan-Meier survival curves demonstrated a lower 360-day cumulative survival rate in the high ACAG group(log-rank χ2=30.680,P＜0.05).After adjusting for confounding factors,multivariate Cox regression analysis showed that high ACAG(＞20 mmol/L)was an independent risk factor for increased 360-day all-cause mortality in severe NSTEMI patients[HR(95%CI)=1.534(1.117-2.107),P＜0.05].Conclusion Elevated ACAG(＞20 mmol/L)at ICU admission is an independent risk factor for increased 360-day all-cause mortality in critically ill patients with severe NSTEMI.