Deans' stroke musings: Plasma anion gap and risk of in-hospital mortality in patients with spontaneous subarachnoid hemorrhage

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 13, 2022

Plasma anion gap and risk of in-hospital mortality in patients with spontaneous subarachnoid hemorrhage

You described a problem, but didn't give the EXACT appropriate treatment regimens. So you missed the mark on this research. You're supposed to solve stroke and get survivors recovered, not just describe the problems they are having. I'd have been fired in no time if I never solved the programming problems I was given.

Plasma anion gap and risk of in-hospital mortality in patients with spontaneous subarachnoid hemorrhage

LinJin Ji¹^†,

Xin Tong²^†,

KaiChun Wang²,

ZhiQun Jiang¹^* and

Aihua Liu²^*

¹Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
²Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Background: The association between the serum anion gap (AG) and prognosis of patients with spontaneous subarachnoid hemorrhage (SAH) remains unknown. Thus, this study aimed to explore the association between AG levels and mortality in patients with SAH in the intensive care unit (ICU).

Methods: This was a retrospective analysis of data stored in the Medical Information Mart for Intensive Care–IV and eICU Collaborative Research databases. Critically ill patients diagnosed with spontaneous SAH were included. The primary outcome measure was in-hospital all-cause mortality. A multivariate Cox proportional hazards regression model and a restricted cubic spline were used to evaluate the relationship between AG concentration and outcomes. Kaplan–Meier curves were used to compare cumulative survival among patients with AG levels.

Results: A total of 1,114 patients were enrolled. AG concentration was significantly associated with in-hospital all-cause mortality [hazard ratio ([HR], 1.076 (95% confidence interval (CI), 1.021–1.292; p = 0.006)]. The risk of mortality was higher in the Category 2 group (AG ≥10 mmol/L and <13 mmol/L; HR, 1.961; 95% CI, 1.157–3.324; p = 0.0) and the Category 3 group (AG ≥13 mmol/L; HR, 2.151; 95% CI, 1.198–3.864; p = 0.010) than in the Category 1 group (AG < 10 mmol/L). Cumulative survival rates were significantly lower in patients with higher AG levels (log-rank p < 0.001).

Conclusions: In-hospital and ICU mortalities increase with increasing AG concentration in patients with SAH. An increased serum AG level is an independent, significant, and robust predictor of all-cause mortality. Thus, serum AG levels may be used in the risk stratification of SAH.

Introduction

Spontaneous subarachnoid hemorrhage (SAH) accounts for 5–10% of all strokes (1). Patients with SAH tend to be younger than patients with other stroke subtypes, thus leading to an enormous burden of premature mortality (2). Half of surviving SAH patients experience long-term neuropsychological complications and lower quality of life (3). Early identification and appropriate treatment regimens can improve the overall survival of patients with SAH. Thus, a robust and easily accessible clinical indicator for determining prognosis is needed for patients with SAH.

The plasma anion gap (AG) is a mathematical derivation parameter calculated using the formula Na⁺+ (Cl⁻ +HCO³⁻). AG has been widely applied in diagnosing various forms of metabolic acidosis for more than 50 years (4). Previous research has found relationships between AG and mortality in patients with many different diseases, such as acute renal failure (5), cerebral infarction (6), acute myocardial infarction (7), acute ischemic stroke (8), coronary artery disease (9), and aortic aneurysms (10). Furthermore, in the general population, which is essentially free of these diseases, higher levels of AG might be of prognostic significance because an increase in AG has been associated with insulin resistance (11), hypertension (12), and low cardiorespiratory fitness (13). However, it is still unknown whether such changes in AG during the course of SAH are associated with a risk difference in mortality. Therefore, this study aimed to investigate the relationship between AG and SAH using publicly accessible clinical databases.