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Anion Gap is a Predictor of Elevated Serum Lactate in Patients Diagnosed with Sepsis without Shock in the Emergency Department

 
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1. Title Title of document Anion Gap is a Predictor of Elevated Serum Lactate in Patients Diagnosed with Sepsis without Shock in the Emergency Department
 
2. Creator Author's name, affiliation, country Chollathip Bunyaphongphan; Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200,; Thailand
 
2. Creator Author's name, affiliation, country Theerapon Tangsuwanaruk; Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200,; Thailand
 
2. Creator Author's name, affiliation, country Borwon Wittayachamnankul; Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200,; Thailand
 
2. Creator Author's name, affiliation, country Chanon Changratanakorn; Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200,; Thailand
 
3. Subject Discipline(s)
 
3. Subject Keyword(s) anion gap, sepsis, septic shock, serum lactate
 
4. Description Abstract

Objective: To determine whether high anion gap levels predict increased serum lactate >2 mmol/L, and to determine the best AG cut-off point for predicting serum lactate levels greater than 2 mmol/L and greater than 4 mmol/L.
Material and Methods: This is a retrospective study among patients with sepsis without shock admitted to the emergency department of a tertiary care, university hospital. Anion gap and serum lactate were collected. Patients’ baseline characteristics and laboratory results were also incorporated to calculate the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score. Analysis of diagnostic accuracy and Receiver Operator Characteristics (ROC) was used to demonstrate the appropriate cut-off point of the anion gap for predicting serum lactate >2 mmol/L.
Results: The study included 236 patients. Anion gap >12 mmol/L had a sensitivity of 93.3% (95%CI 88.2-96.6%) and a specificity of 13.7% (95%CI 6.8-23.8%) for predicting serum lactate >2 mmol/L. There was poor discriminative performance of the anion gap to predict serum lactate >2 mmol/L (area under ROC is 0.65; 95%CI 0.58-0.72). In contrast, there was good discriminative performance of the anion gap to predict serum lactate >4 mmol/L (area under ROC 0.83; 95%CI 0.77-0.88). The optimal cut-off point was anion gap > 18 mmol/L, which was good for predicting serum lactate >4 mmol/L.
Conclusion: An anion gap >12 mmol/L is not suitable for assessing lactate >2 mmol/L; however, an anion gap >18 mmol/L can predict serum lactate >4 mmol/L in patients with sepsis who had mean arterial pressure (MAP) >65 mmHg.
 
5. Publisher Organizing agency, location Faculty of Medicine, Prince of Songkla University
 
6. Contributor Sponsor(s)
 
7. Date (YYYY-MM-DD) 2025-06-23
 
8. Type Status & genre Peer-reviewed Article
 
8. Type Type
 
9. Format File format PDF
 
10. Identifier Uniform Resource Identifier https://www.jhsmr.org/index.php/jhsmr/article/view/1233
 
10. Identifier Digital Object Identifier (DOI) http://dx.doi.org/10.31584/jhsmr.20251233
 
11. Source Title; vol., no. (year) Journal of Health Science and Medical Research; Online-first
 
12. Language English=en en
 
13. Relation Supp. Files
 
14. Coverage Geo-spatial location, chronological period, research sample (gender, age, etc.)
 
15. Rights Copyright and permissions Copyright (c) 2025 Journal of Health Science and Medical Research Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.