Department of Medicine, School of Medicine, University of California - Irvine, Orange, CA, USA.
PINC AI Applied Sciences, Premier Inc., Charlotte, NC, USA.
Am J Med Sci. 2022 Oct;364(4):444-453. doi: 10.1016/j.amjms.2022.04.029. Epub 2022 Apr 29.
Hyperkalemia (HK) may be associated with poor clinical outcomes among COVID-19 patients. This study aimed to describe the prevalence of HK and evaluate the associations between HK and in-hospital mortality, intensive care unit (ICU) admission, length of hospital stay (LOS), and hospitalization cost among COVID-19 inpatients.
A retrospective cohort study was conducted using a large hospital discharge database (PINC AI Healthcare Database) for COVID-19 inpatients discharged between April 1 and August 31, 2020. HK was defined with discharge diagnosis and potassium binder use.
Of 192,182 COVID-19 inpatients, 12% (n = 22,702) had HK. HK patients were more likely to be older (median age 67 vs 63 years), male (63% vs 50%), black (30% vs 22%), and have a history of chronic kidney disease (45% vs 16%) or diabetes mellitus (55% vs 35%) than non-HK patients (all p<.001). A significantly higher proportion of patients with HK had in-hospital mortality (42% vs 11%, p<.001) than those without HK; this was persistent after adjusting for confounders (adjusted odds ratio [OR] 1.69, 95% confidence interval [CI]1.62-1.77). Patients with HK were also more likely to be admitted to ICU (OR 1.05, 95% CI 1.01-1.09), incur higher cost of care (adjusted mean difference $5,389) and have longer LOS (adjusted mean difference 1.3 days) than non-HK patients.
Presence of HK was independently associated with higher in-hospital mortality, LOS, and cost of care among COVID-19 inpatients. Detecting and closely monitoring HK are recommended to improve clinical outcomes and reduce LOS and healthcare cost among COVID-19 patients.
高钾血症（HK）可能与 COVID-19 患者的临床预后不良有关。本研究旨在描述 HK 在 COVID-19 住院患者中的流行情况，并评估 HK 与住院死亡率、重症监护病房（ICU）入院、住院时间（LOS）和住院费用之间的关系。
使用大型医院出院数据库（PINC AI Healthcare Database）对 2020 年 4 月 1 日至 8 月 31 日出院的 COVID-19 住院患者进行回顾性队列研究。根据出院诊断和钾结合剂的使用情况定义 HK。
在 192182 例 COVID-19 住院患者中，有 12%（n=22702）患有 HK。与非 HK 患者相比，HK 患者更有可能年龄较大（中位数年龄 67 岁 vs 63 岁）、男性（63% vs 50%）、黑人（30% vs 22%），且有慢性肾脏病（45% vs 16%）或糖尿病（55% vs 35%）病史（均 p<.001）。HK 患者的住院死亡率（42% vs 11%，p<.001）明显高于非 HK 患者；调整混杂因素后仍存在此差异（校正优势比 [OR] 1.69，95%置信区间 [CI]1.62-1.77）。与非 HK 患者相比，HK 患者更有可能入住 ICU（OR 1.05，95% CI 1.01-1.09）、产生更高的医疗费用（调整后的平均差异为 5389 美元）和 LOS 更长（调整后的平均差异为 1.3 天）。
HK 的存在与 COVID-19 住院患者的住院死亡率、LOS 和医疗费用增加独立相关。建议检测和密切监测 HK，以改善 COVID-19 患者的临床预后，降低 LOS 和医疗成本。
