Strong ion difference and gap predict outcomes after adult burn injury

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: The strong ion difference (SID) (apparent [SIDa] and effective [SIDe]) and strong ion gap (SIG) provide a comprehensive method of evaluating acid-base status in critically ill patients. The SID is the difference between strong cations and strong anions in plasma, while the SIG demonstrates the presence of unmeasured ions. This approach accounts for changes in a patient's protein status, which is particularly important in those with burn injuries. We hypothesized that the SIDa, SIDe, and SIG during the first 72 hours after admission would be predictive of mortality in burn patients. METHODS: This study is a retrospective review of adults with 20% or greater total body surface area burns admitted during a 7-year period to a regional burn center. SIDa, SIDe, and SIG were calculated at admission and for the first 3 days. These results were then compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) scores. RESULTS: A total of 113 patients met the criteria and had full data sets, with mean ± SEM age of 45.4 ± 1.4 years and total body surface area burn of 41.4% ± 1.6%. Mortality was 27.4%. At admission, APACHE II remained most predictive of mortality (p = 0.006). However, admission SIG (SIDa-SIDe) was also predictive of mortality on multivariate analysis (odds ratio, 1.11). Day 1 SIDa (Na+ + K+ + Ca2++ Mg2+-Cl -) and SIDe ([1,000 × 2.46 × 10-11 × PaCO2/10-pH] + [[albumin] × (0.123 × pH-0.631)] + [[PO4] × (0.309) × pH-0.469)]) were also associated with mortality (odds ratio, 1.16 and 1.13 respectively), and SIDe with length of stay and ventilator days (p < 0.05). CONCLUSION: The SID and SIG are predictive of mortality, hospital length of stay, and ventilator days in adult burn patients. They also elucidate complex acid-base disorders.

Original languageEnglish (US)
Pages (from-to)555-561
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Ions
Wounds and Injuries
Sudden Infant Death
Mortality
Length of Stay
APACHE
Body Surface Area
Mechanical Ventilators
Odds Ratio
Organ Dysfunction Scores
Burn Units
Acids
Burns
Critical Illness
Anions
Cations
Albumins
Sepsis
Multivariate Analysis
Proteins

Keywords

  • acid-base status
  • burn
  • Strong ion difference
  • strong ion gap

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Strong ion difference and gap predict outcomes after adult burn injury. / Berndtson, Allison E.; Palmieri, Tina L; Greenhalgh, David G; Sen, Soman.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 4, 10.2013, p. 555-561.

Research output: Contribution to journalArticle

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title = "Strong ion difference and gap predict outcomes after adult burn injury",
abstract = "BACKGROUND: The strong ion difference (SID) (apparent [SIDa] and effective [SIDe]) and strong ion gap (SIG) provide a comprehensive method of evaluating acid-base status in critically ill patients. The SID is the difference between strong cations and strong anions in plasma, while the SIG demonstrates the presence of unmeasured ions. This approach accounts for changes in a patient's protein status, which is particularly important in those with burn injuries. We hypothesized that the SIDa, SIDe, and SIG during the first 72 hours after admission would be predictive of mortality in burn patients. METHODS: This study is a retrospective review of adults with 20{\%} or greater total body surface area burns admitted during a 7-year period to a regional burn center. SIDa, SIDe, and SIG were calculated at admission and for the first 3 days. These results were then compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) scores. RESULTS: A total of 113 patients met the criteria and had full data sets, with mean ± SEM age of 45.4 ± 1.4 years and total body surface area burn of 41.4{\%} ± 1.6{\%}. Mortality was 27.4{\%}. At admission, APACHE II remained most predictive of mortality (p = 0.006). However, admission SIG (SIDa-SIDe) was also predictive of mortality on multivariate analysis (odds ratio, 1.11). Day 1 SIDa (Na+ + K+ + Ca2++ Mg2+-Cl -) and SIDe ([1,000 × 2.46 × 10-11 × PaCO2/10-pH] + [[albumin] × (0.123 × pH-0.631)] + [[PO4] × (0.309) × pH-0.469)]) were also associated with mortality (odds ratio, 1.16 and 1.13 respectively), and SIDe with length of stay and ventilator days (p < 0.05). CONCLUSION: The SID and SIG are predictive of mortality, hospital length of stay, and ventilator days in adult burn patients. They also elucidate complex acid-base disorders.",
keywords = "acid-base status, burn, Strong ion difference, strong ion gap",
author = "Berndtson, {Allison E.} and Palmieri, {Tina L} and Greenhalgh, {David G} and Soman Sen",
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T1 - Strong ion difference and gap predict outcomes after adult burn injury

AU - Berndtson, Allison E.

AU - Palmieri, Tina L

AU - Greenhalgh, David G

AU - Sen, Soman

PY - 2013/10

Y1 - 2013/10

N2 - BACKGROUND: The strong ion difference (SID) (apparent [SIDa] and effective [SIDe]) and strong ion gap (SIG) provide a comprehensive method of evaluating acid-base status in critically ill patients. The SID is the difference between strong cations and strong anions in plasma, while the SIG demonstrates the presence of unmeasured ions. This approach accounts for changes in a patient's protein status, which is particularly important in those with burn injuries. We hypothesized that the SIDa, SIDe, and SIG during the first 72 hours after admission would be predictive of mortality in burn patients. METHODS: This study is a retrospective review of adults with 20% or greater total body surface area burns admitted during a 7-year period to a regional burn center. SIDa, SIDe, and SIG were calculated at admission and for the first 3 days. These results were then compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) scores. RESULTS: A total of 113 patients met the criteria and had full data sets, with mean ± SEM age of 45.4 ± 1.4 years and total body surface area burn of 41.4% ± 1.6%. Mortality was 27.4%. At admission, APACHE II remained most predictive of mortality (p = 0.006). However, admission SIG (SIDa-SIDe) was also predictive of mortality on multivariate analysis (odds ratio, 1.11). Day 1 SIDa (Na+ + K+ + Ca2++ Mg2+-Cl -) and SIDe ([1,000 × 2.46 × 10-11 × PaCO2/10-pH] + [[albumin] × (0.123 × pH-0.631)] + [[PO4] × (0.309) × pH-0.469)]) were also associated with mortality (odds ratio, 1.16 and 1.13 respectively), and SIDe with length of stay and ventilator days (p < 0.05). CONCLUSION: The SID and SIG are predictive of mortality, hospital length of stay, and ventilator days in adult burn patients. They also elucidate complex acid-base disorders.

AB - BACKGROUND: The strong ion difference (SID) (apparent [SIDa] and effective [SIDe]) and strong ion gap (SIG) provide a comprehensive method of evaluating acid-base status in critically ill patients. The SID is the difference between strong cations and strong anions in plasma, while the SIG demonstrates the presence of unmeasured ions. This approach accounts for changes in a patient's protein status, which is particularly important in those with burn injuries. We hypothesized that the SIDa, SIDe, and SIG during the first 72 hours after admission would be predictive of mortality in burn patients. METHODS: This study is a retrospective review of adults with 20% or greater total body surface area burns admitted during a 7-year period to a regional burn center. SIDa, SIDe, and SIG were calculated at admission and for the first 3 days. These results were then compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) scores. RESULTS: A total of 113 patients met the criteria and had full data sets, with mean ± SEM age of 45.4 ± 1.4 years and total body surface area burn of 41.4% ± 1.6%. Mortality was 27.4%. At admission, APACHE II remained most predictive of mortality (p = 0.006). However, admission SIG (SIDa-SIDe) was also predictive of mortality on multivariate analysis (odds ratio, 1.11). Day 1 SIDa (Na+ + K+ + Ca2++ Mg2+-Cl -) and SIDe ([1,000 × 2.46 × 10-11 × PaCO2/10-pH] + [[albumin] × (0.123 × pH-0.631)] + [[PO4] × (0.309) × pH-0.469)]) were also associated with mortality (odds ratio, 1.16 and 1.13 respectively), and SIDe with length of stay and ventilator days (p < 0.05). CONCLUSION: The SID and SIG are predictive of mortality, hospital length of stay, and ventilator days in adult burn patients. They also elucidate complex acid-base disorders.

KW - acid-base status

KW - burn

KW - Strong ion difference

KW - strong ion gap

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