Dyskalemia at admission to an intensive care unit (ICU) may increase patients’ risk for cardiac events and death, especially when the condition the potassium abnormality is not corrected within 2 days, according to new findings from a French study published in Critical Care.
Using 1999 to 2014 data from the OUTCOMEREA database, Lila Bouadma, MD, PhD, of Université Paris Diderot in Paris, and colleagues examined outcomes among 12,090 patients admitted to 22 ICUs. The team stratified patients by admission serum potassium into a normokalemia group (3.5 to 5 mmol/L); 3 hypokalemia groups (mild, moderate, and severe), and 3 hyperkalemia groups (mild, moderate, and severe). The main study outcome was 28-day mortality.
Overall, 17.4% of patients had hypokalemia and 12% had hyperkalemia. Investigators found a higher prevalence of hyperkalemia and hypokalemia among patients with a chronic kidney disease (27%) and in immunosuppressed patients (21%).
Compared with normokalemia, moderate hypokalemia was associated with significant 47% increased odds for cardiac events in adjusted analyses. Mild and severe hypokalemia were not significantly associated with cardiac event risk. Mild, moderate, and severe hyperkalemia were associated with significant 22%, 49%, and 89% increased risks for cardiac events, respectively.
Mild hyperkalemia was associated with significant 29% increased odds of death within 28 days compared with normokalemia in adjusted analyses. Moderate and severe hyperkalemia did not significantly increased the risk of 28-day mortality. Severe hypokalemia increased the risk of 28-day mortality by a nonsignificant 29%.
Failure to correct serum potassium levels by day 2 increased the risk of adjusted 28-day mortality. Overall, dyskalemia was associated with a nonsignificant 24% increased risk, but persistent dyskalemia at day 2 was associated with a significant 45% increased risk of adjusted 28-day mortality.
In addition, patients undergoing renal replacement therapy on day 1 or 2 had a significant 34% risk for early death.
Whether dyskalemia is a true cause of excess mortality responsive to treatment or merely a marker of ICU patient complexity is unclear, Dr Bouadma’s team stated.
Bouadma L, Mankikian S, Darmon M, et al. Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients. Critical Care 23:415. doi: 10.1186/s13054-019-2679-z