高血清阴离子间隙与中重度创伤性脑损伤患者长期全因死亡率的关系：一项回顾性观察性研究

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【中图分类号】 R651 【文献标志码】 A 【文章编号】 1672-7770（2025）04-0430-08

Association high serum anion gap with long-term all-cause mortality in moderate-to-severe traumatic brain injury： a retrospective observational study HE Jie， ZHANG Rui， PAN Yunsong，HU Fangqi， ZHOU Hui. ， the ， 222000，China

Corresponding author： ZHOU Hui

Abstract：Objective To investigate the effect serum anion gap（AG） and long-term allcause mortality（ACM） on the first day after admisson for severe traumatic brain injury（TBI） in the intensive care unit，based on whether there is a difference in mortality with hypertonic saline treatment in the early high serum AG subgroup. MethodsA total 1 178 patients with msTBI admitted to the intensive care unit were selected from the Information Mart for Intensive CareIV（MIMIC-IV 3.O）database for analysis. ResultsThe ACM was 31.58% at 30th day in the high serum AG group and 38.37% at 180th day. Mortality was higher in the high AG group compared to the low serum AG group. Long-term survival was significantly lower in the high serum AG group，with a hazard ratio（HR） 1. 429. After adjusting for pupillary reflex，age and GCS score，the HR for30 and180 ACM were1.71（ 95% CI=1.36-2.14）and 1.59（ 95% CI= 1.30-1.94），respectively. The IMPACT core model validated a 180-day AUC 0.82，and after incorporating serum AG and blood urea nitrogen levels， the AUC increased to 0.84（P<0.05） .In both serum AG groups，there was no significant difference between HTS treatment and long-term ACM， HR=1 . 360 （ P>0.01 ）.ConclusionsIn a population patients with msTBI，higher serum AG levels（ ⩾15mEq/L ） are strongly correlated with increased long-term ACM，making it an independent risk factor for predicting poor prognosis.However，limited evidence indicates that HTS therapy does not lead to increased ACM in patients with high serum AG levels. Key words： traumatic brain injury； serum anion gap；hypertonic saline； mortality

外伤性脑损伤（traumaticbraininjury，TBI）是世界范围内导致死亡和残疾的主要原因。（剩余13394字）