血清钾在急性心力衰竭住院患者中的预后意义。
Prognostic significance of serum potassium in patients hospitalized for acute heart failure.
机构信息
Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, P.zza Spedali Civili, 1, Brescia, 25125, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
出版信息
ESC Heart Fail. 2022 Aug;9(4):2357-2366. doi: 10.1002/ehf2.13925. Epub 2022 May 11.
AIM
We investigated the prognostic significance of serum potassium abnormalities at discharge in patients hospitalized for acute heart failure (AHF).
METHODS AND RESULTS
In a retrospective analysis, we included 926 patients hospitalized for AHF, stratified by serum potassium levels at discharge as hypokalaemia (<3.5 mEq/L), normokalaemia (3.5-5.0 mEq/L), and hyperkalaemia (>5.0 mEq/L). The primary endpoint was all-cause death at 1 year since hospital discharge. At discharge, 40 patients had hypokalaemia (4.3%), 840 normokalaemia (90.7%), and 46 hyperkalaemia (5.0%). Patients with hyperkalaemia at discharge were more frequently men, had more signs of congestion, and lower LVEF while patients with hypokalaemia were more likely to be women with HFpEF. Treatment with ACEi/ARBs and MRAs ≥50% of target dose at discharge was similar across groups. One year all-cause death occurred in 10% of the patients with hypokalaemia, 13.9% of those with normokalaemia, and 30.4% of those with hyperkalaemia (P = 0.006). After adjustment for covariates, including renal function, background treatment, and baseline potassium level, hyperkalaemia resulted an independent predictor of the primary endpoint (HR 1.96, 95% IC [1.01-3.82]; P = 0.048).
CONCLUSIONS
In patients with AHF, the presence of hyperkalaemia at discharge is an independent predictor of 1 year all-cause death.
目的
我们研究了急性心力衰竭（AHF）住院患者出院时血清钾异常的预后意义。
方法和结果
在回顾性分析中，我们纳入了 926 名因 AHF 住院的患者，根据出院时的血清钾水平分层为低钾血症（<3.5mEq/L）、正常钾血症（3.5-5.0mEq/L）和高钾血症（>5.0mEq/L）。主要终点是自出院后 1 年的全因死亡。出院时，40 名患者有低钾血症（4.3%），840 名患者为正常钾血症（90.7%），46 名患者为高钾血症（5.0%）。出院时患有高钾血症的患者更多为男性，有更多充血的迹象，LVEF 更低，而患有低钾血症的患者更可能是 HFpEF 的女性。出院时使用 ACEi/ARBs 和 MRAs 的目标剂量≥50%的治疗在各组之间相似。低钾血症患者中有 10%、正常钾血症患者中有 13.9%、高钾血症患者中有 30.4%在 1 年内发生全因死亡（P=0.006）。在校正包括肾功能、背景治疗和基线钾水平在内的混杂因素后，高钾血症仍然是主要终点的独立预测因素（HR 1.96，95%CI [1.01-3.82]；P=0.048）。
结论
在 AHF 患者中，出院时存在高钾血症是 1 年全因死亡的独立预测因素。
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