Introduction:

There is clinical evidence that the strong ion gap obtained by Stewart’s acid-base approach is a better predictor of mortality than those obtained by the traditional approach in some critically ill patients.

Objective:

To evaluate the strong ion gap clearance kinetics in patients with septic shock during the first 48 hours in the intensive care unit.

Material and methods:

A retrospective, observational study obtained from a patient database in a private intensive care unit in Monterrey, Nuevo León. Patient’s demographics were analyzed, along with data collected from their laboratory work at admission and at 24 and 48 hours to calculate traditional acid-base parameters and parameters obtained by the Stewart’s method. Clearance at 48 hours was also calculated to track their changes over time and to evaluate their relation to patient mortality.

Results:

Data from 91 patients with septic shock admitted between June 2014 and June 2016 were studied, with a 28.6% mortality rate. Lactate clearance, corrected anion gap clearance and strong ion gap clearance at 48 hours were not related to patient mortality, although their individual values at 48 hours were able to predict mortality. The best predictor of mortality was AGCOR at 48, with an area under the ROC curve of 0.71805, compared with an area under the ROC curve of 0.67367 for SIG at 48 hours.

Conclusions:

Strong ion gap changes over the first 48 hours were associated with mortality; however, they do not offer any advantage over traditional acid-base parameters in patients with septic shock.

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