Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2162-e2175. doi: 10.1210/clinem/dgab029.
Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality.
We aimed to determine the association between infused potassium concentration and in-hospital mortality.
Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia.
We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further.
Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality.
全球指南建议在糖尿病酮症酸中毒患者的初始液体治疗中补充 10 至 40mmol/L 的钾。然而，目前尚缺乏钾输注浓度与死亡率之间关系的证据。
本研究旨在确定输注钾浓度与院内死亡率之间的关系。
我们使用日本诊断程序组合数据库，回顾性地确定了 2010 年 7 月至 2018 年 3 月期间因糖尿病酮症酸中毒入院治疗的患者。排除存在肾功能障碍或血清钾异常的患者。我们使用多元回归分析中的三次样条模型评估了住院前 2 天内总输注液中钾浓度与 28 天院内死亡率的关系。我们还评估了钾浓度与高钾血症发生之间的关系。
我们共纳入了 14216 例糖尿病酮症酸中毒患者，观察到 261 例死亡。钾浓度的四分位切点为 7.7、11.4 和 16.1mmol/L。在大约 10 至 40mmol/L 的范围内，钾浓度与高钾血症的发生或死亡无关。较低的钾浓度与较高的 28 天院内死亡率相关；接受 8mmol/L 钾的患者的优势比为 1.69（95%CI，1.03 至 2.78；参考：20mmol/L），并且随着钾浓度进一步降低，优势比呈单调递增。
接受 10 至 40mmol/L 浓度的钾补充的患者的院内死亡率相似，而较低的浓度与较高的死亡率相关。
