Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry
Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry
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DOI：
10.1002/ejhf.1757
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发表时间：
2020-02-20
影响因子：
18.2
通讯作者：
Lund, Lars H.
中科院分区：
文献类型：
--
作者：
Cooper, Lauren B.;Benson, Lina;Lund, Lars H.
高钾血症和低钾血症在心力衰竭中很常见，并与不良结局相关。然而，钾的最佳范围是未知的。我们试图通过2006年1月1日至2012年12月31日瑞典心力衰竭登记处研究基线钾水平与短期和长期结果之间的关系，确定心力衰竭和射血分数降低（< 40%）患者的最佳钾水平范围。在单变量和多变量分层和限制性三次样条考克斯回归中，30天、12个月和最长随访时的死亡率。在13015例患者中，93.3%的患者钾3.5-5.0 mmol/L，3.7%的患者钾5.0 mmol/L。钾5.0 mmol/L更常见，估计肾小球滤过率较低，心力衰竭持续时间较长，严重程度较高。在30天、12个月和最长随访时，与死亡风险最低相关的钾水平为4.2 mmol/L，钾水平较高和较低时风险均急剧增加。在调整分层分析，低钾是独立相关的全因死亡率在12个月和最大的后续行动，而高钾水平只增加风险在30 day.Conclusion，在这个全国注册，钾和死亡率之间的关系是U形的，与最佳钾值为4.2 mmol/L。多变量校正后，低钾血症与长期死亡率增加相关，而高钾血症与短期死亡率增加相关。
Aims Hyperkalaemia and hypokalaemia are common in heart failure and associated with worse outcomes. However, the optimal potassium range is unknown. We sought to determine the optimal range of potassium in patients with heart failure and reduced ejection fraction (< 40%) by exploring the relationship between baseline potassium level and short- and long-term outcomes using the Swedish Heart Failure Registry from 1 January 2006 to 31 December 2012.Methods and results We assessed the association between baseline potassium level and all-cause mortality at 30 days, 12 months, and maximal follow-up, in uni- and multivariable stratified and restricted cubic spline Cox regressions. Of 13 015 patients, 93.3% had potassium 3.5-5.0 mmol/L, 3.7% had potassium 5.0 mmol/L. Potassium 5.0 mmol/L were more common with lower estimated glomerular filtration rate and heart failure of longer duration and greater severity. The potassium level associated with the lowest hazard risk for mortality at 30 days, 12 months, and maximal follow-up was 4.2 mmol/L, and there was a steep increase in risk with both higher and lower potassium levels. In adjusted strata analyses, lower potassium was independently associated with all-cause mortality at 12 months and maximal follow-up, while higher potassium levels only increased risk at 30 days.Conclusion In this nationwide registry, the relationship between potassium and mortality was U-shaped, with an optimal potassium value of 4.2 mmol/L. After multivariable adjustment, hypokalaemia was associated with increased long-term mortality but hyperkalaemia was associated with increased short-term mortality.