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Observational Study
. 2024 Jun 1;24(1):95.
doi: 10.1186/s12873-024-01011-z.

The impact of hyperkalemia on ICU admission and mortality: a retrospective study of Chinese emergency department data

Jian Sun #  1 , Qingyuan Liu #  2 , Samuel Seery #  3   4 , Lu Sun #  1 , Yuan Yuan  1 , Wenwen Wang  1 , Yan Wang  1 , Ziwei Cui  1 , Yueguo Wang  1 , Yulan Wang  1 , Jiashan Zhu  1 , Mengping Zhang  5 , Yinglei Lai  6 , Kui Jin  7
Affiliations
Observational Study

The impact of hyperkalemia on ICU admission and mortality: a retrospective study of Chinese emergency department data

Jian Sun et al. BMC Emerg Med. .

Abstract

Objective: This study assesses the influence of hyperkalemia on both disease severity and the risk of mortality among patients admitted to the emergency room.

Methods: This retrospective observational study utilized data from the Chinese Emergency Triage Assessment and Treatment database (CETAT, version 2.0), which was designed to evaluate and optimize management strategies for emergency room (ER) patients. Patients were systematically categorized based on serum potassium levels. Relationships between serum potassium levels, risk of mortality, and the severity of illness were then analyzed using multifactorial logistic regression and through Receiver Operating Characteristic (ROC) analysis. The effectiveness of various treatments at lowering potassium levels was also investigated.

Results: 12,799 emergency patients were enrolled, of whom 20.1% (n = 2,577) were hypokalemic and 2.98% (n = 381) were hyperkalemic. Among hyperkalemic patients, the leading reasons for visiting the ER were altered consciousness 23.88% (n = 91), cardiovascular symptoms 22.31% (n = 85), and gastrointestinal symptoms 20.47% (n = 78). Comparative analysis with patients exhibiting normal potassium levels revealed hyperkalemia as an independent factor associated with mortality in the ER. Mortality risk appears to positively correlate with increasing potassium levels, reaching peaks when blood potassium levels ranged between 6.5 and 7.0. Hyperkalemia emerged as a strong predictor of death in the ER, with an Area Under the Curve (AUC) of 0.89. The most frequently prescribed treatment for hyperkalemia patients was diuretics (57.32%, n = 188), followed by intravenous sodium bicarbonate (50.91%, n = 167), IV calcium (37.2%, n = 122), insulin combined with high glucose (27.74%, n = 91), and Continuous Renal Replacement Therapy (CRRT) for 19.82% (n = 65). Among these, CRRT appeared to be the most efficacious at reducing potassium levels. Diuretics appeared relatively ineffective, while high-glucose insulin, sodium bicarbonate, and calcium preparations having no significant effect on the rate of potassium decline.

Conclusion: Hyperkalemia is common in emergency situations, especially among patients with altered consciousness. There is a strong positive correlation between the severity of hyperkalemia and mortality risk. CRRT appears to be the most effective potassium reducting strategy, while the use of diuretics should be approached with caution.

Keywords: Disease severity; Emergency room; Hyperkalemia; Mortality risk.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant selection process(a), and Percentage Of Patients With Hyperkalemia In The Emergency Room With Related Symtoms (b)
Fig. 2
Fig. 2
Mortality and morbidity of different serum potassium levels among emergency hyperkalemic patients
Fig. 3
Fig. 3
ROC analyses of (a) ICU admission and (b) in-room fatality risk
Fig. 4
Fig. 4
Venn diagram of therapeutic combinations with potassium-lowering drugs
See this image and copyright information in PMC

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