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. 2025 Aug 16;17(8):e90247.
doi: 10.7759/cureus.90247. eCollection 2025 Aug.

Pneumonia and Hypokalemia Outcomes Investigated in a Rural, Midwestern Population

Mason P Penske  1 , Claire E Reagen  1 , Amanda M Sonnenburg  1 , Megan A Unrath  2 , Scott A Andelin  3   4 , Nova D Beyersdorfer  3 , Kerry D Johnson  5 , John D Paulson  1   4
Affiliations

Pneumonia and Hypokalemia Outcomes Investigated in a Rural, Midwestern Population

Mason P Penske et al. Cureus. .

Abstract

Background Pneumonia is a broad term encompassing lung infections with varying causes, presentations, and prognoses. The objective of this study was to determine if the presence of hypokalemia in subjects admitted to the hospital for pneumonia was associated with an increased mortality rate compared to subjects admitted with pneumonia without hypokalemia. Finding comorbidities associated with worse outcomes in subjects with pneumonia could improve treatment and subsequently improve morbidity and mortality rates. Methods This retrospective study used data from the Freeman Health System (FHS) electronic medical record in Joplin and Neosho, MO, from January 1, 2019, to December 31, 2021. Hospital admissions of subjects ≥18 years old with pneumonia, hypokalemia, or both were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes related to pneumonia and hypokalemia. Of the 4,414 subjects with pneumonia, 1,045 concurrently had hypokalemia, and 3,369 did not. Additionally, 3,594 subjects had hypokalemia without pneumonia. Mortality rates of sample groups were assessed and compared. Results Of the sample groups identified, the mortality rate for subjects with pneumonia and hypokalemia was the highest at 218 (20.86%), followed by pneumonia without hypokalemia at 567 (16.83%), and hypokalemia but no pneumonia at 195 (5.43%). The two-sample comparison tests showed the differences in mortality rates in the three sample groups, which were all statistically significant. Conclusions The group with pneumonia and hypokalemia had a higher mortality rate than the group with pneumonia without hypokalemia or hypokalemia without pneumonia. This data suggests that hypokalemia was associated with increased mortality in subjects with pneumonia. This finding opens up discussion for identifying other comorbidities that may be present in subjects with pneumonia and could help decision-making in the care of subjects with pneumonia prior to hospitalization, upon admission, or during hospitalization.

Keywords: comorbidity; hospital mortality; hypokalemia; pneumonia; retrospective study; rural hospital.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Freeman Health System issued approval 2022003. Subject identifiers were removed to maintain anonymity and confidentiality. The Institutional Review Board (IRB) at FHS approved this study under the IRB protocol: Risk Factors for Poor Outcomes in Patients Admitted with the Diagnosis of Pneumonia. Due to the retrospective nature of this study, consent was not required. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Mortality rate of the three sample groups.
The Y-axis represents the mortality rate with the associated 95% confidence interval (CI). The X-axis represents the three sample groups, P1 (pneumonia with hypokalemia), P2 (pneumonia without hypokalemia), and P3 (hypokalemia without pneumonia) from Table 2.  A two-sample proportion test using Wald’s method was used to analyze the data.
See this image and copyright information in PMC

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