ObjectivesOur objectives were (1) to characterize the distribution of serum potassium levels at ICU admission, (2) to examine the relationship between dyskalemia at ICU admission and occurrence of cardiac events, and (3) to study both the association between dyskalemia at ICU admission and dyskalemia correction by day 2 on 28-day mortality.DesignInception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1999–2014)Setting22 French OUTCOMEREA network ICUsPatientsPatients were classified into six groups according to their serum potassium level at admission: three groups of hypokalemia and three groups of hyperkalemia defined as serious hypokalemia [K+] < 2.5 and serious hyperkalemia [K+] > 7 mmol/L, moderate hypokalemia 2.5 ≤ [K+] < 3 mmol/L and moderate hyperkalemia 6 < [K+] ≤ 7 mmol/L, and mild hypokalemia 3 ≤ [K+] < 3.5 mmol/L and mild hyperkalemia 5 < [K+] ≤ 6 mmol/L. We sorted evolution at day 2 of dyskalemia into three categories: balanced, not-balanced, and overbalanced.InterventionNoneMeasurements and main resultsOf 12,090 patients, 2108 (17.4%) had hypokalemia and 1445 (12%) had hyperkalemia.Prognostic impact of dyskalemia and its correction was assessed using multivariate Cox models. After adjustment, hypokalemia and hyperkalemia were independently associated with a greater risk of 28-day mortality. Mild hyperkalemic patients had the highest mortality (hazard ratio (HR) 1.29, 95% confidence interval (CI) [1.13–1.47], p < 0.001). Adjusted 28-day mortality was higher if serum potassium level was not-balanced at day 2 (aHR = 1.51, 95% CI [1.30–1.76], p < 0.0001) and numerically higher but not significantly different if serum potassium level was overbalanced at day 2 (aHR = 1.157, 95% CI [0.84–1.60], p = 0.38). Occurrence of cardiac events was evaluated by logistic regression. Except for patients with serious hypokalemia at admission, the depth of dyskalemia was associated with increased risk of cardiac events.ConclusionsDyskalemia is common at ICU admission and associated with increased mortality. Occurrence of cardiac events increased with dyskalemia depth. A correction of serum potassium level by day 2 was associated with improved prognosis.

中文翻译：

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入院时血钾异常及早期纠正血钾对危重症患者生存和心脏事件的影响

和轻度低钾血症 3 ≤ [K+] < 3.5 mmol/L 和轻度高钾血症 5 < [K+] ≤ 6 mmol/L。我们将血钾障碍第 2 天的演变分为三类：平衡、不平衡和过度平衡。干预无测量和主要结果 在 12,090 名患者中，2108 名 (17.4%) 患有低钾血症，1445 (12%) 名患有高钾血症。使用多变量 Cox 模型评估校正。调整后，低钾血症和高钾血症与更大的 28 天死亡率风险独立相关。轻度高钾血症患者的死亡率最高（风险比 (HR) 1.29，95% 置信区间 (CI) [1.13–1.47]，p < 0.001）。如果第 2 天血清钾水平不平衡，则调整后的 28 天死亡率更高（aHR = 1.51，95% CI [1.30–1.76]，p < 0。0001），如果血清钾水平在第 2 天过度平衡，则数值更高但没有显着差异（aHR = 1.157，95% CI [0.84–1.60]，p = 0.38）。通过逻辑回归评估心脏事件的发生。除了入院时出现严重低钾血症的患者外，血钾异常的深度与心脏事件风险增加有关。结论 ICU 入院时血钾异常常见且与死亡率增加有关。心脏事件的发生率随着血钾障碍深度的增加而增加。到第 2 天时血清钾水平的校正与预后的改善有关。血钾障碍的深度与心脏事件风险的增加有关。结论 血钾障碍在入住 ICU 时很常见，并且与死亡率增加有关。心脏事件的发生率随着血钾障碍深度的增加而增加。到第 2 天时血清钾水平的校正与预后的改善有关。血钾障碍的深度与心脏事件风险的增加有关。结论 血钾障碍在入住 ICU 时很常见，并且与死亡率增加有关。心脏事件的发生率随着血钾障碍深度的增加而增加。到第 2 天时血清钾水平的校正与预后的改善有关。