{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:11:07Z","timestamp":1790118667993,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Respiratory J"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>For critically ill patients in the intensive care unit (ICU), acute respiratory failure (ARF) stands as a prominent cause of mortality. Anion gap (AG) denotes the disparity between unmeasured cations and anions. Adjusting AG for albumin levels results in the albumin corrected anion gap (ACAG), which provides a more accurate representation of the body's acid\u2013base status. Elevated ACAG may arise from ARF\u2010induced cellular hypoxia and metabolic acidosis. However, limited research has investigated the association between ACAG and the 28\u2010day all\u2010cause mortality of ARF patients in critical care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Medical Information Mart for Intensive Care (MIMIC\u2010IV 2.2) database, a retrospective data analysis was conducted, specifically targeting critically ill patients diagnosed with ARF. Serum ACAG was collected within 24\u2009hours of the patient's admission to the ICU. The association between ACAG levels and 28\u2010day all\u2010cause mortality was investigated using smooth curve fitting, a multivariate Cox proportional hazard regression model, and Kaplan\u2013Meier survival curve analysis. Furthermore, the consistency of these relationships was assessed through interaction and subgroup analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study involved the enrollment of 3888 eligible participants in total. After adjusting for confounding variables in the multivariable Cox regression analysis model, we noticed a positive linear relationship between the ACAG value and the ICU's 28\u2010day all\u2010cause mortality rate. When ACAG was used as a continuous variable, a 3.1% increase in 28\u2010day all\u2010cause mortality was associated with a 1.0\u2010mmol\/L increase in ACAG (adjusted HR\u2009=\u20091.037, 95% CI: 1.025\u20131.048, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In the 28\u2010day all\u2010cause mortality, the highest and intermediate ACAG groups (adjusted HR 1.483, 95% CI: 1.244\u20131.768 and adjusted HR 1.244, 95% CI: 1.062\u20131.457, respectively) were notably higher than the lowest ACAG group when ACAG was utilized as a tertiles categorical variable. The substantial association between ACAG and 28\u2010day all\u2010cause mortality in the ICU was consistently demonstrated through subgroup analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among ICU patients with ARF, an elevated ACAG is linked to an elevated risk of 28\u2010day all\u2010cause mortality. There exists a linearly positive relationship between the 28\u2010day all\u2010cause mortality and ACAG.<\/jats:p><\/jats:sec>","DOI":"10.1111\/crj.70100","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T14:40:52Z","timestamp":1752072052000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association Between Albumin Corrected Anion Gap and 28\u2010Day All\u2010Cause Mortality in Patients With Acute Respiratory Failure in ICU: A Retrospective Study Based on the MIMIC\u2010IV Database"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0551-6893","authenticated-orcid":false,"given":"Jianmin","family":"Qu","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit Tongxiang First People's Hospital  Tongxiang Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiahong","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit Tongxiang First People's Hospital  Tongxiang Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8130-3537","authenticated-orcid":false,"given":"Yi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Xinhua Hospital Shanghai Jiaotong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2126-8535","authenticated-orcid":false,"given":"Wei","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Xinhua Hospital Shanghai Jiaotong University School of Medicine  Shanghai China"},{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfeng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Punan Hospital, Pudong New Area  Shanghai 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