The value of serial anion gap measurement and its efficiency as a prognostic marker for mortality in adult multiple trauma patients admitted to the intensive care unit

Abdelwahab, Ali Taha; Fawzy, Maryam Gerges; Elhoseny, Sahar Adly Mohamed

doi:10.21608/svuijm.2025.419506.2272

The value of serial anion gap measurement and its efficiency as a prognostic marker for mortality in adult multiple trauma patients admitted to the intensive care unit

Document Type : Original research articles

Authors

Anesthesiology and Intensive Care Department, Faculty of Medicine, Minia University , Minia, Egypt

10.21608/svuijm.2025.419506.2272

Abstract

Background: Trauma remains one of the leading causes of morbidity and mortality worldwide, with timely identification of high-risk patients being critical for improving outcomes. The anion gap (AG) has been studied as a prognostic marker in various critical conditions. However, its value in predicting mortality among adult trauma patients remains underexplored.
Objectives: to evaluate the mortality predicting value of AG among adult trauma patients.
Patients and methods: This double-blinded prospective observational study included 196 adult patients with multiple traumas admitted to the intensive care unit of the anesthesia department of Minia University, between June 2018 and September 2019. Demographic data, clinical variables, and laboratory parameters were collected. Serial serum anion gap measurements were recorded at admission, 12, 24, and 48 hours. The primary outcome is to assess the association between AG trends and in-hospital mortality.
Results: Among the 196 patients, non-survivors (64 patients, 32.7% of the cohort) exhibited persistently elevated or rising AG values, while survivors demonstrated significant AG decline within the first 48 hours. Patients who died had higher AG values at admission (p < 0.01), and their AG remained persistently elevated at 48 hours (p < 0.01). Patients in the highest AG tertile had a markedly increased risk of mortality (OR 3.42, 95% CI: 1.12–8.59, p < 0.05).
Conclusion: Serial measurement of the serum AG provides a reliable, cost-effective, and easily accessible prognostic tool for predicting mortality in multiple adult trauma patients in the ICU. Incorporating AG trends into trauma care protocols enhances early risk stratification and clinical decision-making.

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