Contribution of albumin-corrected anion gap and associated biomarkers to the mortality of patients with congestive heart failure: a retrospective cohort study

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BACKGROUND: Albumin-corrected anion gap (ACAG) is a prognostic biomarker for various diseases. As a derived metric, the relationship between ACAG and potential related biomarkers, along with their combined effect on death, has yet to be fully elucidated. This study aims to investigate the association between ACAG and mortality of congestive heart failure (CHF), and to identify the specific biomarkers related to increased ACAG and the risk of mortality in CHF. METHODS: This study selected patients with CHF in intensive care units (ICU) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were stratified based on their ACAG levels into four groups. The outcomes were 28-day and 1-year mortality of CHF. Cox proportional hazard analysis and subgroup analysis were performed to explore the predictive value of ACAG. The mediation analysis and Pearson correlation analysis were used to explore potential associated biomarkers. RESULTS: A total of 2,689 patients with CHF were included in this study. Of these, 697 and 1,207 patients died within 28 days and 1 year, respectively. Cox proportional hazard analysis showed that increased ACAG level was significantly associated with both 28-day and 1-year mortality (hazard ratio [HR]: 2.18, 95%CI: [1.67, 2.84] and HR: 1.44, 95%CI: [1.18, 1.74], respectively) after adjusting for confounding factors. The subgroup analysis demonstrated that ACAG exhibited a pronounced predictive value among patients admitted to the coronary care unit (CCU), or with myocardial infarction in both 28-day and 1-year mortality. The mediating effect of ACAG was found to be significant between lactate, phosphate and blood urea nitrogen (BUN) concerning 28-day mortality (mediated proportion: 44.0%, 37.4% and 16.5%, respectively), but not 1-year mortality. All three biomarkers showed significant correlations with ACAG. CONCLUSIONS: Elevated ACAG was a significant risk factor for 28-day and 1-year mortality in critically ill patients with CHF. ACAG plays an important role in mediating the association between lactate, phosphate and BUN and 28-day death in CHF patients.

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