Holm Aki, Lascarrou Jean Baptiste, Cariou Alain, Reinikainen Matti, Laitio Timo, Kirkegaard Hans, Søreide Eldar, Taccone Fabio Silvio, Lääperi Mitja, B Skrifvars Markus
Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Movement - Interactions - Performance, MIP, UR 4334, 44000 Nantes, France; AfterROSC Network, Paris, France.
Resuscitation. 2024 Dec;205:110439. doi: 10.1016/j.resuscitation.2024.110439. Epub 2024 Nov 20.
Abnormal serum potassium levels are commonly found in the intensive care unit (ICU) population. We aimed to determine the prevalence of potassium disorders at ICU admission and its association with functional outcomes in comatose patients resuscitated from cardiac arrest.
We performed a post hoc analysis of pooled data from four randomised clinical trials involving comatose post-cardiac arrest patients admitted to ICU after return of spontaneous circulation (ROSC). Reference serum potassium levels were defined as between 3.0 and 4.9 mmol/L. An unfavourable functional outcome was defined as a cerebral performance category of 3 to 5 at 180 days. We compared potassium disturbances categorically in a mixed effects logistic regression model including initial rhythm, delay from collapse to return of spontaneous circulation, bystander cardiopulmonary resuscitation, lactate and urea at ICU admission, with normokalaemia set as the reference group.
We included 1133 patients (557 from the HYPERION, 346 from the TTH48, 120 from the COMACARE, and 110 from the Xe-HYPOTHECA trials) with a median age of 64 years (interquartile range 55-72) and a predominance of males (72 %); a total of 712 (64 %) patients had unfavourable functional outcomes. On admission, 221 patients (19.5 %) experienced hyperkalaemia and 35 (3.1 %) patients experienced hypokalaemia. Fewer patients in the normokalaemia group (513/877, 58.5 %) had an unfavourable functional outcome compared to the hypokalaemia (24/35, 68.6 %) and hyperkalaemia groups (180/221, 81.4 %; p < 0.001). Hyperkalaemia was associated with higher odds for an unfavourable functional outcome (adjusted odds ratio (OR) 1.85, 95 % confidence interval (CI) 1.10-3.12, p = 0.02), while hypokalaemia was not (OR 1.36 95 % CI 0.51-3.60, p = 0.53). The associations were not significant in a subgroup analysis adjusted for the modified cardiac arrest hospital prognosis score in 833 patients (OR 1.74, 95 % CI 0.91-3.34, p = 0.10 for hyperkalaemia and OR 1.48, 95 % CI 0.40-5.44, p = 0.55 for hypokalaemia).
Of the comatose patients admitted to ICU after cardiac arrest, one in five experienced a potassium disorder on ICU admission. Hyperkalaemia was associated with unfavourable functional outcomes at 180 days, while hypokalaemia was not.
血清钾水平异常在重症监护病房（ICU）患者中很常见。我们旨在确定心脏骤停复苏后昏迷患者入住ICU时钾紊乱的患病率及其与功能结局的关联。
我们对四项随机临床试验的汇总数据进行了事后分析，这些试验涉及心脏骤停后昏迷且自主循环恢复（ROSC）后入住ICU的患者。参考血清钾水平定义为3.0至4.9 mmol/L。不良功能结局定义为180天时脑功能分类为3至5级。我们在一个混合效应逻辑回归模型中对钾紊乱进行分类比较，该模型包括初始心律、从心脏停搏到自主循环恢复的延迟时间、旁观者心肺复苏、入住ICU时的乳酸和尿素水平，以血钾正常组作为参照组。
我们纳入了1133例患者（来自HYPERION试验的557例、TTH48试验的346例、COMACARE试验的120例和Xe - HYPOTHECA试验的110例），中位年龄为64岁（四分位间距55 - 72岁），男性占多数（72%）；共有712例（64%）患者出现不良功能结局。入院时，221例患者（19.5%）发生高钾血症，35例患者（3.1%）发生低钾血症。与低钾血症组（24/35，68.6%）和高钾血症组（180/221，81.4%）相比，血钾正常组中出现不良功能结局的患者较少（5
