血清钾水平异常与心律失常和心血管死亡率的关联：观察性研究的系统评价和荟萃分析。

Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality: a Systematic Review and Meta-Analysis of Observational Studies.

机构信息

Network Aging Research, University of Heidelberg, Heidelberg, Germany.

Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.

出版信息

Cardiovasc Drugs Ther. 2018 Apr;32(2):197-212. doi: 10.1007/s10557-018-6783-0.

DOI:10.1007/s10557-018-6783-0

PMID:29679302

Abstract

PURPOSE

To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes.

METHODS

Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses.

RESULTS

Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02-2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14-1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60-3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03-1.23]) and chronic kidney disease (1.34 [1.06-1.71]) patients.

CONCLUSIONS

Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes.

REGISTRATION DETAILS

Registration in PROSPERO (Centre for Reviews and Dissemination University of York, York, UK): CRD42016048897 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=48897 ).

摘要

目的

对有关血清钾异常与心血管结局相关性的观察性研究进行系统回顾和荟萃分析。

方法

系统检索了 Medline 和 ISI Web of Knowledge 数据库，检索时间截至 2017 年 11 月 24 日。采用随机效应模型荟萃分析对相关研究的数据进行综合分析。

结果

荟萃分析纳入了 24 项研究的 310825 名参与者。在老年人群中，低血清钾与室上性心律失常的风险增加 1.6 倍相关（风险比[95%置信区间]1.62[1.02-2.55]）。相反，高血清钾与心血管死亡率（CVM）增加相关（1.38[1.14-1.66]）。在急性心肌梗死患者中，高血清钾与室性心律失常的风险增加相关（2.33[1.60-3.38]）。在高血压患者中观察到复合心血管结局呈“U”形关联（低钾血症风险增加 2.6 倍，高钾血症风险增加 1.7 倍），在透析患者中观察到 CVM（低钾血症风险增加 1.1 倍，高钾血症风险增加 1.4 倍）和心力衰竭患者中观察到 CVM（尽管无统计学意义）。此外，只有高钾血症与透析（1.12[1.03-1.23]）和慢性肾脏病（1.34[1.06-1.71]）患者的复合心血管结局风险增加相关。