Use of Sodium-Chloride Difference and Corrected Anion Gap as Surrogates of Stewart Variables in Critically Ill Patients

Jihad Mallat, Stéphanie Barrailler, Malcolm Lemyze, Florent Pepy, Gaëlle Gasan, Laurent Tronchon and Didier Thevenin

PLOS ONE, 2013, vol. 8, issue 2, 1-8

Abstract: Introduction: To investigate whether the difference between sodium and chloride ([Na+] – [Cl−]) and anion gap corrected for albumin and lactate (AGcorr) could be used as apparent strong ion difference (SIDapp) and strong ion gap (SIG) surrogates (respectively) in critically ill patients. Methods: A total of 341 patients were prospectively observed; 161 were allocated to the modeling group, and 180 to the validation group. Simple regression analysis was used to construct a mathematical model between SIDapp and [Na+] – [Cl−] and between SIG and AGcorr in the modeling group. Area under the receiver operating characteristic (ROC) curve was also measured. The mathematical models were tested in the validation group. Results: in the modeling group, SIDapp and SIG were well predicted by [Na+] – [Cl−] and AGcorr (R2 = 0.973 and 0.96, respectively). Accuracy values of [Na+] – [Cl−] for the identification of SIDapp acidosis ( 47.5 mEq/L) were 0.992 (95% confidence interval [CI], 0.963–1) and 0.998 (95%CI, 0.972–1), respectively. The accuracy of AGcorr in revealing SIG acidosis (>8 mEq/L) was 0.974 (95%CI: 0.936–0.993). These results were validated by showing excellent correlations and good agreements between predicted and measured SIDapp and between predicted and measured SIG in the validation group (R2 = 0.977; bias = 0±1.5 mEq/L and R2 = 0.96; bias = −0.2±1.8 mEq/L, respectively). Conclusions: SIDapp and SIG can be substituted by [Na+] – [Cl−] and by AGcorr respectively in the diagnosis and management of acid-base disorders in critically ill patients.

Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0056635

DOI: 10.1371/journal.pone.0056635

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