Miura Yusuke, Higuchi Satoshi, Kohno Takashi, Shiraishi Yasuyuki, Kitamura Mitsunobu, Nagatomo Yuji, Takei Makoto, Nakano Shintaro, Goda Ayumi, Soejima Kyoko, Kohsaka Shun, Yoshikawa Tsutomu
Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo 181-8611, Japan.
Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8555, Japan.
J Clin Med. 2022 Dec 11;11(24):7358. doi: 10.3390/jcm11247358.
Dyskalemia (hypokalemia and hyperkalemia) is a common comorbidity of heart failure (HF). Although dyskalemia is associated with poor prognosis, different prognostic impacts of hypo- and hyperkalemia remain vastly unclear. This study investigated the association of dyskalemia with prognosis in HF patients, especially the mode of death and left ventricular ejection fraction (LVEF). The multicenter study included 3398 patients hospitalized for HF. Patients were divided into three groups based on serum potassium levels at discharge: hypokalemia (<3.5 mEq/L; n = 115 (3.4%)), normokalemia (3.5−5.0 mEq/L; n = 2960 (87.1%)), and hyperkalemia (≥5.0 mEq/L; n = 323 (9.5%)). Two-year all-cause, cardiac, and non-cardiac mortality was evaluated. Association of serum potassium with two-year mortality demonstrated a U-shaped curve, with a worse prognosis for patients with hypokalemia. All-cause mortality at two-years did not differ among the three groups. Hypokalemia was associated with 2-year cardiac death (adjusted hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20−5.64) in HF with reduced ejection fraction (HFrEF; LVEF < 40%), but not in non-HFrEF. Regardless of LVEF, hyperkalemia was not independently associated with any mortality. Hypokalemia was independently associated with cardiac death, particularly in HFrEF patients. Such an association was not observed in hyperkalemia regardless of LVEF.
钾代谢异常（低钾血症和高钾血症）是心力衰竭（HF）常见的合并症。尽管钾代谢异常与预后不良相关，但低钾血症和高钾血症对预后的不同影响仍极不清楚。本研究调查了钾代谢异常与HF患者预后的关系，尤其是死亡方式和左心室射血分数（LVEF）。这项多中心研究纳入了3398例因HF住院的患者。根据出院时的血清钾水平将患者分为三组：低钾血症（<3.5 mEq/L；n = 115（3.4%））、血钾正常（3.5−5.0 mEq/L；n = 2960（87.1%））和高钾血症（≥5.0 mEq/L；n = 323（9.5%））。评估了两年的全因死亡率、心脏死亡率和非心脏死亡率。血清钾与两年死亡率的关联呈U形曲线，低钾血症患者的预后较差。三组患者两年的全因死亡率无差异。低钾血症与射血分数降低的HF（HFrEF；LVEF < 40%）患者的两年心脏死亡相关（校正风险比（HR），2.60；95%置信区间（CI），1.20−5.64），但在非HFrEF患者中无此关联。无论LVEF如何，高钾血症均与任何死亡率无独立关联。低钾血症与心脏死亡独立相关，尤其是在HFrEF患者中。无论LVEF如何，高钾血症均未观察到这种关联。
