Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Department of Basic and Clinical Neuroscience, School of Neuroscience, King's College London, London, UK.
Clin Exp Med. 2024 Aug 13;24(1):190. doi: 10.1007/s10238-024-01452-7.
Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the 'hidden' human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017-Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5-5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5-5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.
高钾血症与住院时间延长和死亡率升高有关。高钾血症可能还需要临床会诊、高钾血症治疗和高依赖床位利用。我们评估了住院患者高钾血症的“隐性”人力和组织资源利用情况。这是一项单中心、观察性队列研究（2017 年 1 月至 2020 年 12 月），在一家三级保健医院进行。CogStack 系统（数据处理和分析平台）用于从单个患者记录中搜索非结构化和结构化数据。使用三次样条回归对钾与死亡之间的关系进行建模，调整年龄、性别和合并症。Cox 比例风险估计与正常血钾（3.5-5.0mmol/L）相比的死亡风险。在急诊室有 129172 名患者进行了钾测量。高钾血症的发病率为每 1000 人 85.7 人。有 49011 例急诊入院。钾>6.5mmol/L 的患者住院死亡率比正常血钾患者高 3.9 倍。慢性肾脏病在钾 5-5.5mmol/L 的患者中占 21%，在钾>6.5mmol/L 的患者中占 54%。对于糖尿病，分别为 20%和 32%。钾>6.5mmol/L 的患者中有 29%接受了肾病学检查，13%接受了重症监护检查；在这一组中，22%转至肾病房，8%转至重症监护病房。在钾>6.5mmol/L 的患者中，有 39%使用了透析。峰值钾>6.5mmol/L 的患者中有 39%使用了透析。入院时高钾血症和低钾血症与降低出院可能性独立相关。高钾血症与更高的院内死亡率和降低出院可能性相关。它需要大量的肾病和重症监护会诊，并更有可能将患者转至肾和重症监护病房。
