Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis
Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis
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DOI：
10.1186/s13613-019-0573-0
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发表时间：
2019-09-05
影响因子：
8.1
通讯作者：
Wollersheim, Tobias
中科院分区：
文献类型：
--
作者：
Engelhardt, Lilian Jo;Balzer, Felix;Wollersheim, Tobias
背景 血清钾浓度通常在 3.5 至 5.0 mmol/l 之间。 ICU 缺乏钾范围和补充的标准化方案。这项对 ICU 患者的回顾性分析的目的是调查钾浓度、变异性和补充情况，及其与院内死亡率的关系。方法 2006 年至 2018 年间在柏林 Charite - Universitatsmedizin 接受治疗的 18 岁以上且血清钾值≥2 的 ICU 患者符合纳入条件。我们将平均钾浓度分为以下几组：< 3.0、3.0-3.5、> 3.5-4.0、> 4.0-4.5、> 4.5-5.0、> 5.0-5.5、> 5.5 mmol/l 和钾变异性：第一、第二和 >= 第三标准差 (SD)。我们分析了特定群体与院内死亡率之间的关联，并进行了二元逻辑回归分析。根据Kaplan-Meier绘制生存曲线并通过Log-Rank进行测试。在一项亚分析中，研究了补钾与院内死亡率之间的关联。结果 在具有 1,337,742 个钾值的 53,248 名 ICU 患者中，平均钾浓度 > 3.5 至 4.0 mmol/l 且第一标准差内钾变异性较低的患者死亡率最低 (3.7%)。二元逻辑回归证实了这些结果。在对 22,406 名 ICU 患者（ICU 入院时间：2013-2018 年）进行的亚组分析中，12,892 名患者 (57.5%) 接受了口服和/或静脉补钾。钾补充与钾类别从 > 3.5 至 4.5 mmol/l 以及第 1、2 和 >= 3 个 SD 中的院内死亡率增加相关（各 p < 0.001）。结论 ICU 患者可能受益于 3.5 至 4.0 mmol/l 之间的目标范围以及最小的钾变异性。必须确定明确的钾目标范围。应认真讨论广泛应用的钾补充剂的标准。
Background Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mortality. Methods ICU patients >= 18 years, with >= 2 serum potassium values, treated at the Charite - Universitatsmedizin Berlin between 2006 and 2018 were eligible for inclusion. We categorised into groups of mean potassium concentrations: < 3.0, 3.0-3.5, > 3.5-4.0, > 4.0-4.5, > 4.5-5.0, > 5.0-5.5, > 5.5 mmol/l and potassium variability: 1st, 2nd and >= 3rd standard deviation (SD). We analysed the association between the particular groups and in-hospital mortality and performed binary logistic regression analysis. Survival curves were performed according to Kaplan-Meier and tested by Log-Rank. In a subanalysis, the association between potassium supplementation and in-hospital mortality was investigated. Results In 53,248 ICU patients with 1,337,742 potassium values, the lowest mortality (3.7%) was observed in patients with mean potassium concentrations between > 3.5 and 4.0 mmol/l and a low potassium variability within the 1st SD. Binary logistic regression confirmed these results. In a subanalysis of 22,406 ICU patients (ICU admission: 2013-2018), 12,892 (57.5%) received oral and/or intravenous potassium supplementation. Potassium supplementation was associated with an increase in in-hospital mortality in potassium categories from > 3.5 to 4.5 mmol/l and in the 1st, 2nd and >= 3rd SD (p < 0.001 each). Conclusions ICU patients may benefit from a target range between 3.5 and 4.0 mmol/l and a minimal potassium variability. Clear potassium target ranges have to be determined. Criteria for widely applied potassium supplementation should be critically discussed.