Huang B P, Zhou Q, Zhao L, Zhao X M, Zhai M, Tian P C, Liang L, Huang L Y, Feng J Y, Zhang Y H, Huang Y, Zhang J
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 14;103(10):727-732. doi: 10.3760/cma.j.cn112137-20220707-01504.
To investigate the relationship between different serum potassium levels at admission and discharge and all-cause mortality in patients with acute heart failure (HF). A total of 2 621 patients with acute HF who were hospitalized in the Heart Failure Center of Fuwai Hospital from October 2008 to October 2017 were analyzed. Patients were divided into three groups according to the different serum potassium levels at admission: hypokalemia with serum potassium<3.5 mmol/L (=329), normokalemia with 3.5-5.5 mmol/L (=2 270), and hyperkalemia with serum potassium>5.5 mmol/L (=22). Clinical data such as patient history, comorbidities, clinical examination and drug use were collected, and systematic outpatient review or telephone follow-up was performed after patients were discharged from the hospital until January 2020. The primary outcome was all-cause death at 90 days, 2 years, and 5 years of follow-up. We compared the clinical characteristics of patients with different serum potassium levels at admission and discharge, and used a multivariate Cox proportional hazards regression model to analyze the association between serum potassium levels at admission and discharge and all-cause mortality. The age of all patients was (58.0±15.3) years old, and 1 877 patients (71.6%) were male. There were 329 (12.6%) and 22 (0.8%) patients with hypokalemia and hyperkalemia at admission, and 38 (1.4%) and 18 (0.7%) at discharge, respectively. The serum potassium levels of all patients were (4.01±0.50) and (4.25±0.44) mmol/L at admission and discharge, respectively. The follow-up time[(,)] of this study was 2.63(1.00,4.42)years, and a total of 1 076 all-cause deaths were recorded at the last follow-up. Compared with patients with normokalemia at discharge, discharged patients with hypokalemia and hyperkalemia were followed up for 90 days (90.3% vs 76.3% vs 38.9%), 2 years (73.8% vs 60.5% vs 33.3%) and 5 years (63.4% vs 44.7% vs 22.2%), respectively, and the difference of which in cumulative survival rates were statistically significant (all values0.001). The multivariate-adjusted Cox regression analysis showed that hypokalemia (=0.979, 95%: 0.812-1.179, =0.820) and hyperkalemia (=1.368, 95%: 0.805-2.325, =0.247) at admission were not associated with all-cause mortality risk, however, hypokalemia (=1.668, 95%: 1.081-2.574, =0.021) and hyperkalemia (=3.787, 95%: 2.264-6.336, <0.001) at discharge were associated with increased all-cause mortality risk. Both hypokalemia and hyperkalemia at discharge in hospitalized patients with acute HF were associated with increased short-and long-term all-cause mortality, and serum potassium levels should be closely monitored.
探讨急性心力衰竭（HF）患者入院和出院时不同血清钾水平与全因死亡率之间的关系。分析了2008年10月至2017年10月在阜外医院心力衰竭中心住院的2621例急性HF患者。根据入院时不同血清钾水平将患者分为三组：血清钾<3.5 mmol/L的低钾血症组（=329例）、3.5 - 5.5 mmol/L的正常血钾组（=2270例）和血清钾>5.5 mmol/L的高钾血症组（=22例）。收集患者病史、合并症、临床检查和用药等临床资料，并在患者出院后进行系统门诊复查或电话随访直至2020年1月。主要结局是随访90天、2年和5年时的全因死亡。比较了入院和出院时不同血清钾水平患者的临床特征，并采用多因素Cox比例风险回归模型分析入院和出院时血清钾水平与全因死亡率之间的关联。所有患者年龄为（58.0±15.3）岁，男性1877例（71.6%）。入院时低钾血症和高钾血症患者分别为329例（12.6%）和22例（0.8%），出院时分别为38例（1.4%）和18例（0.7%）。所有患者入院和出院时血清钾水平分别为（4.01±0.50）和（4.25±0.44）mmol/L。本研究随访时间[(,)]为2.63（1.00,4.42）年，末次随访共记录1076例全因死亡。与出院时血钾正常的患者相比，出院时低钾血症和高钾血症患者90天（90.3% vs 76.3% vs 38.9%）、2年（73.8% vs 60.5% vs 33.3%）和5年（63.4% vs 44.7% vs 22.2%）的随访率分别不同，累积生存率差异有统计学意义（所有 值<0.001）。多因素校正Cox回归分析显示，入院时低钾血症（=0.979，95%：0.812 - 1.179，=0.820）和高钾血症（=
