{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T18:10:05Z","timestamp":1754071805633,"version":"3.41.2"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Diabetic kidney disease (DKD) is one of the most common diabetic complications and is closely related to metabolic acidosis. The serum anion gap (AG), an important index of acid-base balance, may reflect disturbed metabolism and be correlated with increased mortality risk. However, the role of AG in all-cause mortality risk in individuals suffering from severe DKD is not yet clear.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this study, patients identified with a diagnosis of severe DKD utilizing MIMIC-IV database were determined. They were subsequently divided into four quartiles based on their serum AG levels. The findings consisted of in-hospital deaths and ICU deaths. The relationship between serum AG levels of severe DKD patients and clinical outcomes was elucidated using Cox proportional hazards regression analysis and RCS analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 1,716 patients (66.43% male) received treatment, with in-hospital and ICU mortality rates reaching 16.43% and 13.17%, respectively. Multivariate Cox regression analysis revealed that elevated serum AG levels were remarkably linked to all-cause mortalities. When adjusted for confounders, elevated serum AG levels correlated notably with in-hospital mortality [HR\u2009=\u20091.09(95%CI:1.07,1.11)P\u2009&lt;\u20090.0001] and ICU mortality [HR\u2009=\u20091.10(95%CI:1.07,1.12)P\u2009&lt;\u20090.0001]. RCS analysis showed that serum AG levels were positively correlated in a linear fashion with all-cause death risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Serum AG shows a significant positive correlation with all-cause mortalities in hospitals and ICU settings among patients with severe DKD. This suggests that serum AG could serve as a potential indication for recognizing DKD individuals with an increased overall risk of all-cause death.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0329269","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T17:37:35Z","timestamp":1754069855000},"page":"e0329269","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between serum anion gap and all-cause mortality in critically ill patients with diabetic kidney disease: Analysis of the MIMIC-IV 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