Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN; Division of Nephrology, Hennepin Healthcare, and Department of Medicine, University of Minnesota, Minneapolis, MN.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN.
Am Heart J. 2021 Nov;241:59-67. doi: 10.1016/j.ahj.2021.07.006. Epub 2021 Jul 19.
While severe hyperkalemia is commonly encountered, its manifestation in hospitalized patients and related outcomes are unclear. We aimed to examine development of hyperkalemia in hospitalized patients and associated outcomes.
Data from a county hospital electronic health record were used to assess all inpatient admissions, 2012-2016, for non-dialysis-dependent patients with ≥1 K value for development of hyperkalemia. Unadjusted odds ratios (ORs) were calculated for associations of the maximum K value with in-hospital mortality and adjusted ORs were calculated for death associated with hyperkalemia.
In 47,018 individual patient hospitalizations, 1.3% had a maximum K ≥6.0 mEq/L and 4.2% <3.5 mEq/L. Fifth and 95th percentiles for maximum K values were 3.5 and 5.3 mEq/L. For high-K patients with a prior K value, the mean (SD) of the immediate pre-maximum K value was 5.0 ± 1.0 mEq/L, and the mean difference in K values (immediate pre-maximum to maximum) was 1.5 ± 1.1 mEq/L; mean duration between these two K tests was 10.7 ± 14.9 hours. Compared with maximum K values 3.5 to 4.0 mEq/L, ORs for death were 37.1 (95% confidence intervals, 25.8-53.3) for K 6.0 to <6.5, 88.6 (56.8-138.2) for K ≥7.0, and 18.9 (4.3-82.2) for K <3.0 mEq/L. In adjusted models, the OR for death for K ≥6.0 mEq/L was 4.9 (3.7-6.4).
DISCUSSION/CONCLUSIONS: Peak K values ≥6.0 mEq/L were associated with mortality. Values tended to increase rapidly, limiting opportunities for detection and treatment. Systems-based approaches to detect life-threatening hyperkalemia should be studied.
重度高钾血症较为常见，但住院患者中的表现及其相关结局尚不清楚。我们旨在研究住院患者高钾血症的发生情况及其相关结局。
我们使用县医院电子病历中的数据评估了 2012 年至 2016 年间所有非透析依赖患者的住院人次，这些患者至少有一次血钾值 ≥1 K，以评估高钾血症的发生情况。我们计算了最大血钾值与住院期间死亡率的未校正比值比（OR），并计算了与高钾血症相关的死亡的校正 OR。
在 47018 例个体患者的住院人次中，有 1.3%的患者最大血钾值 ≥6.0 mEq/L，4.2%的患者最大血钾值 <3.5 mEq/L。最大血钾值的第 5 百分位数和第 95 百分位数分别为 3.5 和 5.3 mEq/L。对于有既往血钾值的高钾血症患者，即时前最大血钾值的平均值（标准差）为 5.0 ± 1.0 mEq/L，血钾值的平均差值（即时前最大与最大）为 1.5 ± 1.1 mEq/L；两次血钾检测之间的平均时间间隔为 10.7 ± 14.9 小时。与最大血钾值 3.5 至 4.0 mEq/L 相比，最大血钾值 6.0 至 <6.5 mEq/L 的死亡 OR 为 37.1（95%置信区间，25.8-53.3），最大血钾值 ≥7.0 mEq/L 的死亡 OR 为 88.6（56.8-138.2），最大血钾值 <3.0 mEq/L 的死亡 OR 为 18.9（4.3-82.2）。在调整后的模型中，最大血钾值 ≥6.0 mEq/L 的死亡 OR 为 4.9（3.7-6.4）。
讨论/结论：最大血钾值 ≥6.0 mEq/L 与死亡率相关。血钾值似乎升高迅速，限制了检测和治疗的机会。应研究基于系统的方法来检测危及生命的高钾血症。
