Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 2;8(7):e011814.
doi: 10.1161/JAHA.118.011814.

Hyperkalemia Is Associated With Increased Mortality Among Unselected Cardiac Intensive Care Unit Patients

Benjamin Brueske  1 , Mandeep S Sidhu  1 , Joshua Schulman-Marcus  1 , Kianoush B Kashani  2   3 , Gregory W Barsness  4 , Jacob C Jentzer  3   4
Affiliations

Hyperkalemia Is Associated With Increased Mortality Among Unselected Cardiac Intensive Care Unit Patients

Benjamin Brueske et al. J Am Heart Assoc. .

Abstract

Background Hyperkalemia has been associated with increased mortality in patients with myocardial infarction, but few data exist regarding hyperkalemia in cardiac intensive care unit ( CICU ) patients. We hypothesize that hyperkalemia is associated with increased mortality in unselected CICU patients. Methods and Results We retrospectively reviewed a historical cohort of 9681 CICU patients admitted from January 2007 to December 2015. Hyperkalemia was defined as admission potassium ≥5.0 mEq/L and hypokalemia as admission potassium <3.5 mEq/L. Multivariate logistic regression was used to determine predictors of in-hospital mortality. Postdischarge survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models. The mean age of included patients was 67±15 years, with 36% females, and in-hospital mortality was 9%. Hyperkalemia occurred in 1187 (12.3%) and hypokalemia occurred in 719 (7.4%) patients. Both patients with hyperkalemia (unadjusted odds ratio, 2.85; 95% CI, 2.40-3.39; P<0.001) and patients with hypokalemia (unadjusted odds ratio, 2.31; 95% CI, 1.85-2.88; P<0.001) were at increased risk of unadjusted in-hospital mortality. After adjustment for illness severity and renal function, only patients with hyperkalemia demonstrated increased risk of in-hospital death (adjusted odds ratio, 1.44; 95% CI, 1.11-1.87; P=0.006). Among hospital survivors, only patients with hyperkalemia had lower postdischarge survival by Kaplan-Meier analysis ( P<0.001). After adjustment for illness severity and renal function, hospital survivors with admission hyperkalemia remained at increased risk for postdischarge mortality (adjusted hazard ratio, 1.20; 95% CI, 1.08-1.34; P<0.001). Conclusions Hyperkalemia on CICU admission is associated with higher in-hospital and postdischarge mortality, independent of renal function and illness severity. These findings emphasize the importance of potassium abnormalities as a risk predictor in patients admitted to the CICU .

Keywords: critical care; intensive care unit; potassium.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CICU and hospital mortality as a function of admission potassium level. CICU indicates cardiac intensive care unit.
Figure 2
Figure 2
Hospital mortality as a function of admission potassium level in patients with and without ACS (A), HF (B), AKI (C), and CKD (D). P<0.0001 for all trends, except for patients with severe AKI (P=0.59). ACS indicates acute coronary syndrome; AKI, acute kidney injury; CKD, chronic kidney disease; HF, heart failure.
Figure 3
Figure 3
CICU and hospital mortality as a function of the highest (A) and lowest (B) potassium level during the CICU stay for the overall population. P<0.001 for trends. CICU indicates cardiac intensive care unit.
Figure 4
Figure 4
Kaplan–Meier survival curves for hospital survivors as a function of admission potassium levels. P<0.001 for comparison between patients with hyperkalemia and other groups; P>0.1 for comparison between hypokalemia and normokalemia.
See this image and copyright information in PMC

References

    1. Younis A, Goldenberg I, Goldkorn R, Younis A, Peled Y, Tzur B, Klempfner R. Elevated admission potassium levels and 1‐year and 10‐year mortality among patients with heart failure. Am J Med Sci. 2017;354:268–277. - PubMed
    1. Colombo MG, Kirchberger I, Amann U, Dinser L, Meisinger C. Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: a systematic review and meta‐analysis. Eur J Prev Cardiol. 2018;25:576–595. - PubMed
    1. Hessels L, Hoekstra M, Mijzen LJ, Vogelzang M, Dieperink W, Lansink AO, Nijsten MW. The relationship between serum potassium, potassium variability and in‐hospital mortality in critically ill patients and a before‐after analysis on the impact of computer‐assisted potassium control. Crit Care. 2015;19:9. - PMC - PubMed
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829. - PubMed
    1. Jentzer JC, Bennett C, Wiley BM, Murphree DH, Keegan MT, Gajic O, Wright RS, Barsness GW. Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population. J Am Heart Assoc. 2018;7:e008169 DOI: 10.1161/JAHA.117.008169. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources