Serum albumin corrected anion gap levels are associated with poor prognosis in patients with acute ischemic stroke
Yaxin Zhang, Fan Wu, Jiawei Sun, Chaoqian Xu, Qingwei Yang, Guangdong Wang
Abstract
Acute ischemic stroke (AIS) remains a major cause of global morbidity and mortality. This study aimed to evaluate the role of albumin corrected anion gap (ACAG) as a prognostic marker for AIS patients. We analyzed data from 1014 AIS patients in the MIMIC-IV database, stratifying patients by ACAG levels. Using Cox proportional hazards models, restricted cubic splines, and Kaplan-Meier survival analysis, we assessed the relationship between ACAG and both 30-day and 365-day mortality. Our results show that elevated ACAG levels are significantly associated with higher mortality rates at both time points. The hazard ratios for 30-day and 365-day mortality were 1.07 (95% CI 1.04-1.11, P < 0.001) and 1.06 (95% CI 1.03-1.09, P < 0.001), respectively. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of ACAG for predicting 30-day and 365-day mortality was 0.666 and 0.662, respectively. Subgroup analysis revealed significant interactions with gender and sepsis status. A nomogram incorporating ACAG and other key variables achieved AUCs of 0.748 and 0.765 for predicting 30-day and 365-day mortality, respectively. These findings indicate that elevated ACAG is an independent risk factor for both short-term and long-term mortality in AIS patients. Its incorporation into clinical practice may enhance the ability of clinicians to identify high-risk patients early, enabling timely and targeted interventions.