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Background/Aim. Acid-base disorders are common within critically ill   patients. Physicochemical approach described by Stewart and modified by   Figge gives precise quantification method of metabolic acidosis and insight   into its main mechanisms, as well as influence of unmeasured anion on   metabolic acidosis. The aims of this study were to determine whether the   conventional acid-base variables are connected with survival rate of   critically ill patients at Intensive care unit; whether strong ion   difference/strong ion gap (SID/SIG) is a better predictor of mortality rate   comparing to conventional acid-base variables; to determine all significant   predictable parameters for the 28-day mortality rate at intensive care   units. Methods. This retrospective observational analytic study included 142   adult patients requiring mechanical ventilation, survivors (n = 68) and   nonsurvivors (n = 74). Apparent strong ion difference (SIDapp), effective   strong ion difference (SIDeff) and SIG values were calculated with the   Stewart-Figge’s quantitative biophysical method. Descriptive and analytical   statistical methods were used in the study [t-test, Mann-Whitney U test,   χ2-test, binary logistic regression, Reciever operating characteristic   (ROC) curves, calibration]. Results. Age, Na+, acute physiology and chronic   health evaluation (APACHE II), Cl-, albumin, SIG, SID app, SIDeff, and   aninon gap (AG) were statistically significant predictors. AG represented a   model with imprecise calibration, i.e. a model with little predictive power.   APACHE II had p-value more than 0.05 if it was near it, and therefore it   could be considered potentially unreliable for outcome prediction. SIDeff   and SIG represented models with well-defined calibration. ROC analysis   results showed that APACHE II, Cl-, albumin, SIDeff, SIG i AG had the   largest area bellow the curve. By creation of logistic models with   calibration methods, we found that outcome depends on SIG and APACHE II   score. Conclusion. Based on our data, unmeasured anions provide prediction   of mortality of critically ill patients on mechanical ventilation, unlike   the traditional acid-base variables which are not accurate predictors of the   28-day mortality rate

Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation