Engelhardt Lilian Jo, Balzer Felix, Müller Michael C, Grunow Julius J, Spies Claudia D, Christopher Kenneth B, Weber-Carstens Steffen, Wollersheim Tobias
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Ann Intensive Care. 2019 Sep 5;9(1):100. doi: 10.1186/s13613-019-0573-0.
Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mortality.
ICU patients ≥ 18 years, with ≥ 2 serum potassium values, treated at the Charité - Universitätsmedizin Berlin between 2006 and 2018 were eligible for inclusion. We categorised into groups of mean potassium concentrations: < 3.0, 3.0-3.5, > 3.5-4.0, > 4.0-4.5, > 4.5-5.0, > 5.0-5.5, > 5.5 mmol/l and potassium variability: 1st, 2nd and ≥ 3rd standard deviation (SD). We analysed the association between the particular groups and in-hospital mortality and performed binary logistic regression analysis. Survival curves were performed according to Kaplan-Meier and tested by Log-Rank. In a subanalysis, the association between potassium supplementation and in-hospital mortality was investigated.
In 53,248 ICU patients with 1,337,742 potassium values, the lowest mortality (3.7%) was observed in patients with mean potassium concentrations between > 3.5 and 4.0 mmol/l and a low potassium variability within the 1st SD. Binary logistic regression confirmed these results. In a subanalysis of 22,406 ICU patients (ICU admission: 2013-2018), 12,892 (57.5%) received oral and/or intravenous potassium supplementation. Potassium supplementation was associated with an increase in in-hospital mortality in potassium categories from > 3.5 to 4.5 mmol/l and in the 1st, 2nd and ≥ 3rd SD (p < 0.001 each).
ICU patients may benefit from a target range between 3.5 and 4.0 mmol/l and a minimal potassium variability. Clear potassium target ranges have to be determined. Criteria for widely applied potassium supplementation should be critically discussed. Trial registration German Clinical Trials Register, DRKS00016411. Retrospectively registered 11 January 2019, http://www.drks.de/DRKS00016411.
血清钾浓度通常在3.5至5.0毫摩尔/升之间。重症监护病房（ICU）缺乏关于钾浓度范围及补充的标准化方案。这项对ICU患者的回顾性分析旨在研究钾浓度、变异性及补充情况，以及它们与院内死亡率的关联。
纳入2006年至2018年期间在柏林夏里特大学医学中心接受治疗、年龄≥18岁且有≥2次血清钾值的ICU患者。我们将平均钾浓度分为以下几组：<3.0、3.0 - 3.5、>3.5 - 4.0、>4.0 - 4.5、>4.5 - 5.0、>5.0 - 5.5、>5.5毫摩尔/升，以及钾变异性：第1、第2和≥第3标准差（SD）。我们分析了特定分组与院内死亡率之间的关联，并进行二元逻辑回归分析。根据Kaplan - Meier法绘制生存曲线，并通过对数秩检验。在一项亚分析中，研究了钾补充与院内死亡率之间的关联。
在53248例有1337742个钾值的ICU患者中，平均钾浓度在>3.5至4.0毫摩尔/升之间且钾变异性处于第1标准差内的患者死亡率最低（3.7%）。二元逻辑回归证实了这些结果。在对22406例ICU患者（ICU入院时间：2013 - 2018年）的亚分析中，12892例（57.5%）接受了口服和/或静脉补钾。钾补充与钾浓度在>3.5至4.5毫摩尔/升之间以及处于第1、第2和≥第3标准差分组中的院内死亡率增加相关（每项p<0.001）。
ICU患者可能从3.5至4.0毫摩尔/升的目标范围和最小的钾变异性中获益。必须确定明确的钾目标范围。应严格讨论广泛应用钾补充的标准。试验注册 德国临床试验注册中心，DRKS00016411。2019年1月11日追溯注册，http://www.drks.de/DRKS00016411。
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