血清钾水平、变异性与急性心肌梗死患者住院期间的死亡率。

Serum potassium level, variability and in-hospital mortality in acute myocardial infarction.

机构信息

Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

China Academy of Chinese Medical Sciences, Beijing, China.

出版信息

Eur J Clin Invest. 2022 Jul;52(7):e13772. doi: 10.1111/eci.13772. Epub 2022 Mar 22.

DOI:10.1111/eci.13772

PMID:35294777

Abstract

OBJECTIVE

Clinical guidelines recommend an optimal serum potassium concentration between 4.0 and 5.0 mmol/L in patients with acute myocardial infarction (AMI), which was based on lower-quality evidence from more than 20 years ago. Therefore, it is essential to re-evaluate the range of optimal potassium levels in patients with AMI in intensive care unit (ICU).

METHODS

This was a retrospective study based on Philips eICU Collaborative Research Database, which covered 9776 patients with AMI between 2014 and 2015. All patients had more than or equal to 2 serum potassium measurements and were categorized by the mean serum potassium level (<3.5, 3.5-4.5, 4.5-5.5, ≥5.5 mmol/L) and potassium variability (1st, 2nd, and ≥3rd standard deviation (SD)). Binary logistic regression was used to determine the association between mean potassium levels, variability and in-hospital mortality in AMI.

RESULTS

Of all 9776 AMI patients in ICU, 8731 (89.3%) patients were included. A total of 69847 potassium measurements were performed in these patients. There was a J-shaped relationship between mean serum potassium level and in-hospital mortality. The lowest mortality (mortality rate, 7.2%; 95% CI, 6.57%-7.76%) was observed in patients with mean potassium level between 3.5 and 4.5 mmol/L and a low potassium variability within the 1st SD. Logistic regression showed that the risk of in-hospital mortality is highest when the mean potassium level ≥5.5 mmol/L (57.6%; 95% Cl, 45.02%-70.24%; multivariable adjusted OR, 14.8; 95% CI, 8.4-26.2) compared to the reference group of 3.5-4.5 mmol/L and potassium variability within the 3rd SD (16.5%; 95% Cl, 15.19%-17.88%; multivariable adjusted OR, 3.3; 95% CI, 2.7-4.1) compared to 1st SD. Several sensitivity analyses confirmed these results.

CONCLUSION

Among AMI patients in ICU, the minimum risk of in-hospital mortality was observed in those with mean potassium levels between 3.5 and 4.5 mmol/L or a minimal potassium variability compared to those who had higher or lower values.

摘要

目的

临床指南建议急性心肌梗死（AMI）患者的血清钾最佳浓度在 4.0-5.0mmol/L 之间，这是基于 20 多年前的低质量证据。因此，有必要重新评估 ICU 中 AMI 患者的最佳钾水平范围。

方法

这是一项基于 Philips eICU 协作研究数据库的回顾性研究，该数据库涵盖了 2014 年至 2015 年间的 9776 例 AMI 患者。所有患者均进行了超过 2 次血清钾测量，并根据平均血清钾水平（<3.5mmol/L、3.5-4.5mmol/L、4.5-5.5mmol/L、≥5.5mmol/L）和钾变异度（1 标准差、2 标准差和≥3 标准差）进行分类。二元逻辑回归用于确定平均钾水平、变异性与 AMI 院内死亡率之间的关系。

结果

在 ICU 中的 9776 例 AMI 患者中，8731 例（89.3%）被纳入研究。这些患者共进行了 69847 次钾测量。平均血清钾水平与院内死亡率呈 J 型关系。在平均钾水平在 3.5-4.5mmol/L 之间且钾变异度在 1 标准差内的患者中，死亡率最低（死亡率为 7.2%；95%CI：6.57%-7.76%）。逻辑回归显示，当平均钾水平≥5.5mmol/L 时，院内死亡率最高（57.6%；95%Cl：45.02%-70.24%；多变量调整后 OR：14.8；95%CI：8.4-26.2），与 3.5-4.5mmol/L 组相比，钾变异度在 3 标准差内的患者风险最高（16.5%；95%Cl：15.19%-17.88%；多变量调整后 OR：3.3；95%CI：2.7-4.1），与 1 标准差相比。几项敏感性分析证实了这些结果。