• Xiao Shen, Lu Ke, Dongliang Yang, Jing Sun, Zhihui Tong, Baiqiang Li, Gang Li, Weiqin Li, Jieshou Li, and Rinaldo Bellomo.
• Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
• J Crit Care. 2016 Dec 1; 36: 140-145.

PurposeIn this study, we aimed to evaluate the predictive value of Stewart-derived parameters for the development of severe type of acute pancreatitis (AP) and for AP-related mortality.MethodsWe studied 186 patients admitted to the hospital with AP. We performed blood gas and biochemical analysis for each patient on admission. We calculated multiple metrics according to the Stewart's acid-base theory and assessed their accuracy as predictors of AP severity and mortality.ResultsOf the 186 patients presenting with AP, 85 (45.7%) developed severe AP and 33 (17.7%) died during hospitalization. Patients with severe AP had significantly higher median strong ion gap (SIG) than did patients with mild or moderate AP (7.88 vs 2.11 mEq/L, P< .001). In multivariate logistic regression analysis, SIG had an odds ratio (OR) of 1.56 (P< .001). In addition, SIG had good predictive power for mortality (OR, 1.26; P= .014) as well as acute kidney injury (OR, 1.34; P< .001).ConclusionsIn a cohort of patients with AP, SIG was a strong independent predictor of severity and mortality. Besides, SIG might also be an early marker for acute kidney injury in AP patients. Additional research is needed to identify the nature of the unmeasured anions responsible for such findings.Copyright © 2016 Elsevier Inc. All rights reserved.

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