Is anion gap helpful for assessing cardiovascular risk in cardiac intensive care unit?

Abstract

In recent years, there is a growing importance of the cardiac intensive care unit (CICU), which is evolved from the conventional coronary care unit (CCU), due to the increasing complexity of CCU patients. [ 1 Kasaoka S. Evolved role of the cardiovascular intensive care unit (CICU). J. Intensive Care. 2017; 5: 1-5 Crossref PubMed Scopus (17) Google Scholar , 2 Na S.J. Chung C.R. Jeon K. Park C.M. Suh G.Y. Ahn J.H. et al. Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J. Am. Coll. Cardiol. 2016; 68: 2637-2648 Crossref PubMed Scopus (62) Google Scholar , 3 Brusca S.B. Barnett C. Barnhart B.J. Weng W. Morrow D.A. Soble J.S. et al. Role of critical care medicine training in the cardiovascular intensive care unit: survey responses from dual certified critical care cardiologists. J. Am. Heart Assoc. 2019; 8e011721 Crossref PubMed Scopus (11) Google Scholar ] Cardiac intensivists are exposed to an increasing amount of non-cardiac organ failures. To date, several scoring methods to stratify the prognosis in critically ill patients, such as sequential organ failure assessment (SOFA) score, acute physiologic and chronic health evaluation (APACHE), and simplified acute physiology score (SAPS), have been developed in the general intensive care unit because early detection of risk factors is beneficial. The SOFA score is a simple scoring system based on six organ failures, which allows us to repeat the evaluation over. [ [4] Vincent J.L. de Mendonça A. Cantraine F. Moreno R. Takala J. Suter P.M. et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit. Care Med. 1998; 26: 1793-1800 Crossref PubMed Google Scholar ] However, since cardiovascular failure in the SOFA score is evaluated by blood pressure alone, it may not be applied to patients admitted to the CICU. [ [5] Bachmann K.F. Arabi Y.M. Regli A. Starkopf J. Reintam Blaser A. Cardiovascular SOFA score may not reflect current practice. Intensive Care Med. 2022; 48: 119-120 Crossref PubMed Scopus (6) Google Scholar ] Combining the anion gap with the sequential organ failure assessment score to evaluate the short-term prognosis of patients in the cardiac intensive care unitInternational Journal of CardiologyVol. 370PreviewWe attempted to determine the predictive ability of the first-day Sequential Organ Failure Assessment (SOFA) score in the cardiac intensive care unit, as well as a new score combining the anion gap (AG) with the SOFA score (SOFA-AG). Full-Text PDF