Lai X X, Xu C, Li G S, Wang L
Department of Nephrology, Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Disease, Chengdu 610072, China.
Information Center, Sichuan Provincial People's Hospital, Chengdu 610072, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 16;101(42):3472-3477. doi: 10.3760/cma.j.cn112137-20210506-01062.
To investigate the prevalence of hyperkalemia in hospitalized patients, and analyze the effects of different serum potassium levels and change rates of serum potassium on the mortality of hospitalized patients. The clinical data of 944 446 hospitalized patients in Sichuan Provincial People's Hospital from January 2009 to December 2018 were retrospectively analyzed. Hyperkalemia is defined as serum potassium ≥ 5.5 mmol/L. The effects of serum potassium level and its change rate on hospitalized mortality were analyzed. There were 15 771 patients with hyperkalemia, and the prevalence of hyperkalemia was 1.7% (15 771/944 446). However, the discharge diagnosis rate was only 11.0% (1 735/15 771), and the missed diagnosis rate was 89.0% (14 036/15 771). Cox regression analysis showed that serum potassium<3.5 mmol/L (=1.338, 95%: 1.164-1.537, <0.001) or ≥ 6.5 mmol/L (=1.421, 95%: 1.158-1.744, =0.001) increased the risk of hospitalized mortality compared with patients with normal serum potassium. Compared with the increased rate of serum potassium by 0.01-0.10 mmol/d, patients who reached the peak of serum potassium at admission (=1.251, 95%: 1.077-1.453, =0.003), increased rate of serum potassium by 0.11-0.51 mmol/d (=1.499, 95%: 1.315-1.709, <0.001) or >0.51 mmol/d (=2.431, 95%: 2.105-2.807, <0.001) increased the risk of mortality. Of patients with hyperkalemia, those who did not repeat the serum potassium test had a higher risk of mortality (=1.656, 95%: 1.434-1.914, <0.001). The prevalence of hyperkalemia in hospitalized patients was 1.7%, and the missed diagnosis rate was high at discharge. Patients who had hypokalemia at admission, severe hyperkalemia, rapid increased serum potassium, or failed to repeat serum potassium test during hospitalization, had higher risk of mortality.
为调查住院患者高钾血症的患病率，并分析不同血清钾水平及血清钾变化率对住院患者死亡率的影响。回顾性分析了四川省人民医院2009年1月至2018年12月期间944446例住院患者的临床资料。高钾血症定义为血清钾≥5.5 mmol/L。分析血清钾水平及其变化率对住院死亡率的影响。共有15771例高钾血症患者，高钾血症患病率为1.7%（15771/944446）。然而，出院诊断率仅为11.0%（1735/15771），漏诊率为89.0%（14036/15771）。Cox回归分析显示，与血清钾正常的患者相比，血清钾<3.5 mmol/L（=1.338，95%：1.164 - 1.537，P<0.001）或≥6.5 mmol/L（=1.421，95%：1.158 - 1.744，P = 0.001）会增加住院死亡风险。与血清钾每日升高0.01 - 0.10 mmol/d相比，入院时血清钾达到峰值的患者（=1.251，95%：1.077 - 1.453，P = 0.003）、血清钾每日升高0.11 - 0.51 mmol/d（=1.499，95%：1.315 - 1.709，P<0.001）或>0.51 mmol/d（=2.431，95%：2.105 - 2.807，P<0.001）死亡风险增加。在高钾血症患者中，未复查血清钾的患者死亡风险更高（=1.656，95%：1.434 - 1.914，P<0.001）。住院患者高钾血症患病率为1.7%，出院时漏诊率较高。入院时低钾血症、严重高钾血症、血清钾快速升高或住院期间未复查血清钾的患者，死亡风险更高。
