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. 2025 May 30:12:1582894.
doi: 10.3389/fmed.2025.1582894. eCollection 2025.

Linear association between serum potassium levels and 28-day mortality among ICU patients with diabetes and sepsis: a multicenter study

Anxiang Cai #  1   2   3   4 , Tianyi Zhang #  1   2   3   4 , Kaiwen Gao #  5 , Xinglin Chen  6 , Shu Li  1   2   3   4 , Qisheng Lin  1   2   3   4 , Shan Mou  1   2   3   4 , Zhaohui Ni  1   2   3   4 , Haijiao Jin  1   2   3   4
Affiliations

Linear association between serum potassium levels and 28-day mortality among ICU patients with diabetes and sepsis: a multicenter study

Anxiang Cai et al. Front Med (Lausanne). .

Abstract

Background: Dysregulation of serum potassium is a common electrolyte disturbance in critically ill patients, and both hypokalemia and hyperkalemia have been linked to adverse outcomes in sepsis. However, the relationship between serum potassium levels and mortality in ICU patients with diabetes and sepsis remains poorly understood.

Methods: A retrospective cohort study was conducted using data from the eICU Collaborative Research Database (2014-2015). The study included 5,104 adult ICU patients with diabetes and sepsis from 208 hospitals in the U.S. Serum potassium levels measured within 24 h of ICU admission were categorized into hypokalemia (<3.5 mmol/L), normokalemia (3.5-5.0 mmol/L), and hyperkalemia (>5.0 mmol/L). Multivariable logistic regression models were used to assess the association between serum potassium levels and 28-day ICU mortality.

Results: Of the 5,104 patients (mean age, 66.8 years; 49.1% male), 1,046 (20.5%) had hypokalemia, 3,377 (66.2%) had normokalemia, and 681 (13.3%) had hyperkalemia. After adjusting for demographic factors, comorbidities, and treatment measures, each 1 mmol/L increase in serum potassium was associated with a 25% higher risk of 28-day mortality (adjusted OR, 1.25; 95% CI, 1.07-1.47). Compared to hypokalemia, hyperkalemia was associated with significantly higher mortality risk (adjusted OR, 1.86; 95% CI, 1.17-2.96). A linear relationship was observed between serum potassium levels and mortality (P = 0.006), differing from the previously reported U-shaped relationship in general ICU populations.

Conclusions and relevance: Elevated serum potassium levels were independently associated with increased 28-day mortality in ICU patients with diabetes and sepsis. These findings suggest that potassium management strategies should be specifically tailored for this high-risk patient population.

Keywords: ICU; diabetes; hyperkalemia; hypokalemia; mortality; sepsis; serum potassium.

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Conflict of interest statement

XC was employed by X&Y Solutions Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of participants selection.
Figure 2
Figure 2
Smooth curve fitting for serum potassium and ICU 28-day mortality in ICU patients with diabetes and sepsis. The red solid line represents the fitted curve, while the blue dotted lines indicate the 95% confidence intervals. The y-axis shows mortality probability (%), and the x-axis displays serum potassium levels (mmol/L).
See this image and copyright information in PMC

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References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. (2016) 315:801–10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed
    1. Vincent J, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care. (2019) 23:196. 10.1186/s13054-019-2478-6 - DOI - PMC - PubMed
    1. Tongyoo S, Viarasilpa T, Permpikul C. Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit. J Int Med Res. (2018) 46:1254–62. 10.1177/0300060517744427 - DOI - PMC - PubMed
    1. Bouadma L, Mankikian S, Darmon M, Argaud L, Vinclair C, Siami S, et al. Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients. Crit Care. (2019) 23:415. 10.1186/s13054-019-2679-z - DOI - PMC - PubMed
    1. McMahon GM, Mendu ML, Gibbons FK, Christopher KB. Association between hyperkalemia at critical care initiation and mortality. Intensive Care Med. (2012) 38:1834–42. 10.1007/s00134-012-2636-7 - DOI - PubMed

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