A study on the prognostic value of the strong ion gap in acute pancreatitis
DOI:
https://doi.org/10.18203/2349-2902.isj20262320Keywords:
Acute pancreatitis, Strong ion gap, Outcome prediction, Anion gapAbstract
Background: Severe acute pancreatitis (SAP) may range up to 20-30%. So, it is important to assess the disease severity in a timely and accurate manner to provide comprehensive treatment to Acute pancreatitis (AP) patients, which will allow the clinician to consider more aggressive interventions to prevent adverse outcomes and decrease the high mortality of SAP.
Methods: This is a prospective cohort study of 61 patients admitted to the KIMS, Hubli from December 2016 to June 2018 with Acute pancreatitis (AP). Blood gas and biochemical analysis for each patient was performed on admission and multiple metrics was calculated according to the Stewart’s acid-base theory and their accuracy was used as predictors of AP severity and mortality. A p value of <0.05 was considered statistically significant.
Results: Of the 61 patients presenting with AP, 6 developed severe AP and 5 died during hospitalization. Patients with severe AP had significantly higher median strong ion gap (SIG) than patients with mild or moderate AP respectively with p<0.001 making SIG strong predictor of severity, mortality and good prognostic indicator.
Conclusions: SIG is a strong independent predictor of severity and mortality. It helps in better triaging, risk stratification, management and prognosis of such patients in the future.
References
Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, et al. Acute pancreatitis: diagnosis and treatment. Drugs. 2022;82(12):1251-76.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603-13.
Metri A, Bush N, Shi GJ. Predicting the severity of acute pancreatitis: current approaches and future directions. SSRN Electron J. 2023.
Berend K. Diagnostic use of base excess in acid–base disorders. N Engl J Med. 2018;378(15):1419-28.
Moviat M, Van Haren F, Van der Hoeven H. Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis. Crit Care. 2003;7(3):R41-5.
Story DA. Bench-to-bedside review: a brief history of clinical acid-base. Crit Care. 2004;8(4):253-8.
Antonini B, Piva S, Paltenghi M, Candiani A, Latronico N. The early phase of critical illness is a progressive acidic state due to unmeasured anions. Eur J Anaesthesiol. 2008;25(7):566-71.
Sharma V, Devi TS, Sharma R, Chhabra P, Gupta R, Rana SS, et al. Arterial pH, bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis: a single-centre prospective study. Gastroenterol Rep (Oxf). 2014;2(3):226-31.
Shen X, Ke L, Yang D, Sun J, Tong Z, Li B, et al. The prognostic value of the strong ion gap in acute pancreatitis. J Crit Care. 2016;36:140-5.
Wang Z, Zhang H, Xie X, Cao F, Li F. Albumin-corrected anion gap predicts acute kidney injury in critically ill patients with acute pancreatitis: a retrospective cohort study. BMC Nephrol. 2025;26(1):348.
Kaplan LJ, Frangos S. Clinical review: Acid-base abnormalities in the intensive care unit part II. Crit Care. 2005;9(2):198-203.
