Lima Ivna G C V, Nunes Jairo T, de Oliveira Igor H, Ferreira Silvia M A, Munhoz Robinson T, Chizzola Paulo R, Biselli Bruno, Gomes Brenno R, Damiani Lucas P, Maria André S, Ronco Fernanda, Bocchi Edimar Alcides
Heart Failure Clinics, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Medical and Hospital Information Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Sci Rep. 2024 Dec 4;14(1):30167. doi: 10.1038/s41598-024-74928-x.
Observational studies suggest a U-shaped association between serum potassium (K⁺) levels and mortality in patients with chronic heart failure (CHF). However, the mode of death in patients with HF and K⁺ disorders remains speculative. To investigate the association between potassium disorders and the mode of death in patients with CHF. A retrospective cohort of 10,378 CHF outpatients was analyzed over an average of 3.28 ± 2.5 years. Kaplan-Meier method, Cox proportional hazards regression models, Poisson regression models adjusting for confounders, and e-value determination (e' > 1.6) were used to observe associations between potassium disorders and outcomes. Chagas etiology (p < 0.01) and triple HF therapy (p < 0.01) were associated with hyperkalemia. Atrial fibrillation was associated with hypokalemia (p < 0.01). Chronic kidney disease (CKD) (p < 0.01) and diabetes (p = 0.03) were associated with both. Hypertension was inversely related to hyperkalemia (p < 0.01); age was inversely related to hypokalemia. Associations with mortality were significant for Chagas (p < 0.01, e-value 2.16), stroke (p < 0.01, e-value 1.85), hypokalemia (p = 0.02, e-value 1.94), severe hyperkalemia (p = 0.08, e-value 1.93), and CKD (p < 0.01, e-value > 1.63). Decompensated HF or cardiogenic shock was the cause of death in 54% of patients with normokalemia, 67.8% with hypokalemia, 44.9% with mild hyperkalemia, 57.8% with moderate hyperkalemia, and 69% with severe hyperkalemia. Most patients with hypokalemia and severe hyperkalemia died from decompensated HF (p = 0.007). Data suggest hypokalemia and severe hyperkalemia, along with Chagas and CKD, are associated with death. Unexpectedly, progressive HF was the most frequent mode of death rather than arrhythmias. Further studies are needed to confirm these findings and explore the underlying mechanisms.
观察性研究表明，慢性心力衰竭（CHF）患者的血清钾（K⁺）水平与死亡率之间呈U形关联。然而，心力衰竭和钾紊乱患者的死亡方式仍具有推测性。为了研究钾紊乱与慢性心力衰竭患者死亡方式之间的关联。对10378例慢性心力衰竭门诊患者进行了回顾性队列分析，平均随访时间为3.28±2.5年。采用Kaplan-Meier法、Cox比例风险回归模型、校正混杂因素的Poisson回归模型以及e值测定（e'＞1.6）来观察钾紊乱与预后之间的关联。恰加斯病因（p＜0.01）和三联心力衰竭治疗（p＜0.01）与高钾血症相关。心房颤动与低钾血症相关（p＜0.01）。慢性肾脏病（CKD）（p＜0.01）和糖尿病（p = 0.03）与两者均相关。高血压与高钾血症呈负相关（p＜0.01）；年龄与低钾血症呈负相关。与死亡率相关的因素包括恰加斯病（p＜0.01，e值2.16）、中风（p＜0.01，e值1.85）、低钾血症（p = 0.02，e值1.94）、严重高钾血症（p = 0.08，e值1.93）和慢性肾脏病（p＜0.01，e值＞1.63）。在血钾正常的患者中，54%的患者死于失代偿性心力衰竭或心源性休克，低钾血症患者为67.8%，轻度高钾血症患者为44.9%，中度高钾血症患者为57.8%，严重高钾血症患者为69%。大多数低钾血症和严重高钾血症患者死于失代偿性心力衰竭（p = 0.007）。数据表明，低钾血症、严重高钾血症以及恰加斯病和慢性肾脏病与死亡相关。出乎意料的是，进行性心力衰竭是最常见的死亡方式，而非心律失常。需要进一步研究来证实这些发现并探索其潜在机制。
