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Using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), we included 861 ICU-admitted patients with AC. AG measurements during the first 96\u00a0h after ICU admission were extracted. Latent class growth modeling (LCGM) identified four AG trajectory classes: Class 1 (persistently low), Class 2 (persistently moderate), Class 3 (persistently elevated), and Class 4 (persistently elevated despite decline). Kaplan\u2013Meier analysis and multivariable Cox regression after comprehensive adjustment for confounders were used to assess associations with 28-day and 90-day all-cause mortality. Over all 28-day and 90-day mortality were 16.7% and 26.5%, respectively. Compared with Class 1, Class 3 and Class 4 showed higher adjusted mortality risks (28-day: Class 3\u00a0h 2.79, 95% CI 1.55\u20135.00,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001; Class 4\u00a0h 4.76, 95% CI 2.33\u20139.72,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001; 90-day: Class 3\u00a0h 2.34, 95% CI 1.49\u20133.68,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001; Class 4\u00a0h 4.12, 95% CI 2.31\u20137.36,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). These findings suggest that dynamic AG monitoring during the early ICU course may help identify high-risk AC patients and inform clinical management.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-48549-5","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T13:54:51Z","timestamp":1775829291000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between anion gap trajectories and mortality in patients with acute cholangitis: a cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Yanhua","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guirong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Mou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"48549_CR1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13054-021-03480-1","volume":"25","author":"JR Lavillegrand","year":"2021","unstructured":"Lavillegrand, J. 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