Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Clin Chem Lab Med. 2021 Feb 22;59(7):1231-1237. doi: 10.1515/cclm-2020-1476. Print 2021 Jun 25.
Severe hyperkalemia can cause life-threatening arrhythmia, cardiac arrest, or death. This study aimed to investigate the incidence and the associated factors relevant to critical hyperkalemia (≥6 mmol/L) among inpatients, outpatients, and emergency department. Their clinical outcomes were also analyzed.
All patients whose high serum potassium values had been reported as critical laboratory values in 2016 were enrolled. Their demographic data, comorbidities, clinical symptoms, biochemical data, and outcomes were reviewed and collected. The Charlson comorbidity score (CCS) and glomerular filtration rate (GFR) were computed to assess the comorbidity burden and renal function. Patients were divided into groups according to different settings, potassium and GFR levels, and their survival.
Of the 293,830 total serum potassium tests, 1,382 (0.47%) reports were listed as critical laboratory values. The average reply time was 6.3 min. Their mean age was 67.2 years, while the average GFR was 12.2 mL/min/1.73 m. The overall mortality rate was 34%. Patients in the emergency department had the highest incidence (0.92%), while inpatients had the worst outcome (51% mortality). The leading cause of mortality was septic shock. The fatal group had higher rates of clinical symptoms, higher potassium values, CCS, and eGFR (all p<0.05).
Most of the responses for the reports were obtained within a short period of time. Patients with reported high critical serum potassium values were characterized by high rates of comorbidity, reduced eGFR, and mortality. The incidence, clinical manifestations, and outcomes varied in the different clinical settings.
严重高钾血症可导致危及生命的心律失常、心脏骤停或死亡。本研究旨在调查住院患者、门诊患者和急诊科患者中严重高钾血症（≥6mmol/L）的发生率及相关因素。分析其临床结局。
纳入 2016 年所有高血清钾值被报告为危急值的患者。回顾并收集了他们的人口统计学数据、合并症、临床症状、生化数据和结局。计算 Charlson 合并症评分（CCS）和肾小球滤过率（GFR）以评估合并症负担和肾功能。根据不同的设置、钾和 GFR 水平以及生存情况将患者分为不同的组。
在 293830 次总血清钾检测中，有 1382 次（0.47%）报告为危急值。平均回复时间为 6.3 分钟。患者的平均年龄为 67.2 岁，平均 GFR 为 12.2mL/min/1.73m。总体死亡率为 34%。急诊科患者的发病率最高（0.92%），而住院患者的结局最差（51%的死亡率）。死亡的主要原因是感染性休克。致命组的临床症状、钾值、CCS 和 eGFR 更高（均 p<0.05）。
大多数危急值报告的回复都在短时间内获得。报告的高血清钾危急值患者的特点是合并症发生率高、eGFR 降低和死亡率高。不同临床环境中的发病率、临床表现和结局存在差异。
