Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1507 1507 EN Amal Sam Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Department of Liver Anaesthesia and Critical Care, The Institute of Liver Disease & Transplantation, Chennai, India. K Nandakumar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. Sruthi Shankar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. Atchya Kumar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. 2025 12 01 2025 12 06 Background: Stewart's method of acid-base analysis involves analyzing the strong ion difference in the blood. The anion gap (AG), strong ion difference (SID), and strong ion gap (SIG) not only assist in diagnosing underlying acid-base disturbances but also serve as prognostic markers. This study aimed to analyze Stewart's approach in patients with cirrhosis. Methods: Acid-base parameters of forty-eight cirrhosis patients requiring intensive care were prospectively studied. The primary objective of this study was to evaluate the prognostic value of SIG. The secondary objective was to examine the correlation between acid-base parameters, such as lactate, base excess of arterial blood gas analysis (ABG-BE), base excess of unmeasured anions [BE (UA)], AG, SID, and SIG. Results: The median SIG was 4.1 (IQR: 2.5 - 5.6). The median albumin-corrected AG (acAG) level was 15 (IQR, 14–20). The median BE (UA) was -4.2 (IQR: -7.1, 1.7). Apparent SID and BE (UA) demonstrated a strong correlation (r = 0.92; p < 0.001). Effective SID was strongly correlated with ABG-BE (r = 0.83, p < 0.001). SIG and acAG showed a strong correlation with an r value of 0.94 (p < 0.001). An ICU stay of more than 8 days was considered prolonged (75th percentile). ABG-BE, SIG, and acAG on admission day effectively predicted prolonged ICU stay, with AUCs of 0.73, 0.75, and 0.78, respectively. Conclusion: SIG effectively predicts prolonged ICU stay with good predictive ability. However, the anion gap, when corrected for albumin, is better than SIG in terms of predictive accuracy, requiring fewer variables and offering greater ease of use. https://aacc.tums.ac.ir/index.php/aacc/article/view/1507