Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients
Abstract Objectives Our 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...
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doaj-c7334315f07e446a893d9f2ed32083802020-12-20T12:14:18ZengBMCCritical Care1364-85352019-12-0123111010.1186/s13054-019-2679-zInfluence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patientsLila Bouadma0Stefan Mankikian1Michael Darmon2Laurent Argaud3Camille Vinclair4Shidasp Siami5Maité Garrouste-Orgeas6Laurent Papazian7Yves Cohen8Guillaume Marcotte9Lenka Styfalova10Jean Reignier11Alexandre Lautrette12Carole Schwebel13Jean-Francois Timsit14on behalf of the OUTCOMEREA STUDY GROUP15UMR 1137, IAME, Université Paris DiderotAP-HP, Pitié-Salpêtrière University Hospital, CardiologyAPHP, Saint-Louis University Hospital, Medical Intensive Care UnitMedical ICU, Edouard Herriot University HospitalUMR 1137, IAME, Université Paris DiderotCritical Care Medicine Unit CH Etampes-DourdanMedical Unit, French British Hospital InstituteRespiratory and Infectious Diseases ICU, APHM Hôpital Nord, Aix Marseille UniversityAP-HP, Avicenne Hospital, Intensive Care UnitSurgical Intensive Care Unit and Lyon University HospitalOUTCOMEREA organizationMedical Intensive Care Unit and University Hospital CentreMedical Intensive Care Unit, Gabriel Montpied University HospitalMedical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 UniversityUMR 1137, IAME, Université Paris DiderotOutcomerea research networkAbstract Objectives Our 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. Design Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1999–2014) Setting 22 French OUTCOMEREA network ICUs Patients Patients 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. Intervention None Measurements and main results Of 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. Conclusions Dyskalemia 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.https://doi.org/10.1186/s13054-019-2679-zPotassiumCorrection of potassiumCritical careMortalityCardiac events |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lila Bouadma Stefan Mankikian Michael Darmon Laurent Argaud Camille Vinclair Shidasp Siami Maité Garrouste-Orgeas Laurent Papazian Yves Cohen Guillaume Marcotte Lenka Styfalova Jean Reignier Alexandre Lautrette Carole Schwebel Jean-Francois Timsit on behalf of the OUTCOMEREA STUDY GROUP |
spellingShingle |
Lila Bouadma Stefan Mankikian Michael Darmon Laurent Argaud Camille Vinclair Shidasp Siami Maité Garrouste-Orgeas Laurent Papazian Yves Cohen Guillaume Marcotte Lenka Styfalova Jean Reignier Alexandre Lautrette Carole Schwebel Jean-Francois Timsit on behalf of the OUTCOMEREA STUDY GROUP Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients Critical Care Potassium Correction of potassium Critical care Mortality Cardiac events |
author_facet |
Lila Bouadma Stefan Mankikian Michael Darmon Laurent Argaud Camille Vinclair Shidasp Siami Maité Garrouste-Orgeas Laurent Papazian Yves Cohen Guillaume Marcotte Lenka Styfalova Jean Reignier Alexandre Lautrette Carole Schwebel Jean-Francois Timsit on behalf of the OUTCOMEREA STUDY GROUP |
author_sort |
Lila Bouadma |
title |
Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
title_short |
Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
title_full |
Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
title_fullStr |
Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
title_full_unstemmed |
Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
title_sort |
influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2019-12-01 |
description |
Abstract Objectives Our 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. Design Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1999–2014) Setting 22 French OUTCOMEREA network ICUs Patients Patients 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. Intervention None Measurements and main results Of 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. Conclusions Dyskalemia 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. |
topic |
Potassium Correction of potassium Critical care Mortality Cardiac events |
url |
https://doi.org/10.1186/s13054-019-2679-z |
work_keys_str_mv |
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