Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: A systematic review and meta-analysis

Colombo, Miriam Giovanna; Kirchberger, Inge; Amann, Ute; Dinser, Lisa; Meisinger, Christa

doi:10.1177/2047487318759694

Cited by 28 publications

(29 citation statements)

References 39 publications

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“…Our findings are in line with results of a recent systematic review, investigating the association of potassium concentration with mortality and occurrence of ventricular arrhythmias in patients after myocardial infarction in 12 studies. In those cardiac risk patients, they found an increased mortality risk when potassium concentrations were above 4.5 mmol/l [12]. In agreement, in patients with atrial fibrillation, we observed the lowest mortality when mean potassium was > 3.5–4.0 mmol/l.…”

Section: Discussionsupporting

confidence: 88%

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Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis

Engelhardt

Balzer

Müller

et al. 2019

Ann. Intensive Care

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Background Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mortality. Methods ICU patients ≥ 18 years, with ≥ 2 serum potassium values, treated at the Charité - Universitätsmedizin Berlin between 2006 and 2018 were eligible for inclusion. We categorised into groups of mean potassium concentrations: < 3.0, 3.0–3.5, > 3.5–4.0, > 4.0–4.5, > 4.5–5.0, > 5.0–5.5, > 5.5 mmol/l and potassium variability: 1st, 2nd and ≥ 3rd standard deviation (SD). We analysed the association between the particular groups and in-hospital mortality and performed binary logistic regression analysis. Survival curves were performed according to Kaplan–Meier and tested by Log-Rank. In a subanalysis, the association between potassium supplementation and in-hospital mortality was investigated. Results In 53,248 ICU patients with 1,337,742 potassium values, the lowest mortality (3.7%) was observed in patients with mean potassium concentrations between > 3.5 and 4.0 mmol/l and a low potassium variability within the 1st SD. Binary logistic regression confirmed these results. In a subanalysis of 22,406 ICU patients (ICU admission: 2013–2018), 12,892 (57.5%) received oral and/or intravenous potassium supplementation. Potassium supplementation was associated with an increase in in-hospital mortality in potassium categories from > 3.5 to 4.5 mmol/l and in the 1st, 2nd and ≥ 3rd SD ( p < 0.001 each). Conclusions ICU patients may benefit from a target range between 3.5 and 4.0 mmol/l and a minimal potassium variability. Clear potassium target ranges have to be determined. Criteria for widely applied potassium supplementation should be critically discussed. Trial registration German Clinical Trials Register, DRKS00016411. Retrospectively registered 11 January 2019, http://www.drks.de/DRKS00016411

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Section: Discussionsupporting

confidence: 88%

“…In summary, previous guidelines recommend potassium concentrations rather in the upper normokalaemic range. However, there is evidence that potassium concentrations above 4.5 mmol/l may be adversely associated with survival in patients with myocardial infarction [8, 12].…”

Section: Introductionmentioning

confidence: 99%

Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis

Engelhardt

Balzer

Müller

et al. 2019

Ann. Intensive Care

View full text Add to dashboard Cite

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“…Sudden cardiac death (SCD), mostly due to ventricular tachyarrhythmias (VTs), contributes to ~50% of HF deaths (Tomaselli and Zipes, 2004 ). Hypokalemia is a well-recognized risk factor for VT, and hypokalemia is both common and independently associated with worse clinical outcomes in HF patients (Cleland et al, 1987 ; Ahmed et al, 2007 ; Bowling et al, 2010 ; Kjeldsen, 2010 ; Aldahl et al, 2017 ; Nunez et al, 2018 ), as well as increasing the risk of ventricular arrhythmias and mortality during acute myocardial infarction (Goyal et al, 2012 ; Colombo et al, 2018 ; Hoppe et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Hypokalemia-Induced Arrhythmias and Heart Failure: New Insights and Implications for Therapy

Skogestad

Aronsen

2018

Front. Physiol.

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Routine use of diuretics and neurohumoral activation make hypokalemia (serum K+ < 3. 5 mM) a prevalent electrolyte disorder among heart failure patients, contributing to the increased risk of ventricular arrhythmias and sudden cardiac death in heart failure. Recent experimental studies have suggested that hypokalemia-induced arrhythmias are initiated by the reduced activity of the Na+/K+-ATPase (NKA), subsequently leading to Ca2+ overload, Ca2+/Calmodulin-dependent kinase II (CaMKII) activation, and development of afterdepolarizations. In this article, we review the current mechanistic evidence of hypokalemia-induced triggered arrhythmias and discuss how molecular changes in heart failure might lower the threshold for these arrhythmias. Finally, we discuss how recent insights into hypokalemia-induced arrhythmias could have potential implications for future antiarrhythmic treatment strategies.

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“…Hypokalemia is known to increase the risk of supraventricular and ventricular arrhythmias, especially when serum potassium is <3.5 mEq/L [7][8][9][10]. A large cohort of 2.6 million patients found that hypokalemia was significantly associated with a 2-fold increased risk of in-hospital mortality among patients with a diagnosis of CHF, regardless of causes of hypokalemia [11].…”

Section: Introductionmentioning

confidence: 99%

Admission Serum Potassium Levels in Hospitalized Patients and One-Year Mortality

et al. 2019

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Background: The aim of this study was to assess the relationship between admission serum potassium and one-year mortality in all adult hospitalized patients. Methods: All adult hospitalized patients who had an admission serum potassium level between the years 2011 and 2013 at a tertiary referral hospital were enrolled. End-stage kidney disease patients were excluded. Admission serum potassium was categorized into levels of ≤2.9, 3.0-3.4, 3.5-3.9, 4.0-4.4, 4.5-4.9, 5.0-5.4, and ≥5.5 mEq/L. Cox proportional hazard analysis was performed to assess the independent association between admission serum potassium and one-year mortality after hospital admission, using an admission potassium level of 4.0-4.4 mEq/L as the reference group. Results: A total of 73,983 patients with mean admission potassium of 4.2 ± 0.5 mEq/L were studied. Of these, 12.6% died within a year after hospital admission, with the lowest one-year mortality associated with an admission serum potassium of 4.0-4.4 mEq/L. After adjustment for age, sex, race, estimated glomerular filtration rate (eGFR), principal diagnosis, comorbidities, medications, acute kidney injury, mechanical ventilation, and other electrolytes at hospital admission, both a low admission serum potassium ≤3.9 mEq/L and elevated admission potassium ≥5.0 mEq/L were significantly associated with an increased risk of one-year mortality, when compared with an admission serum potassium of 4.0-4.4 mEq/L. Subgroup analysis of chronic kidney disease and cardiovascular disease patients showed similar results. Conclusion: This study demonstrated that hypokalemia ≤3.9 mEq/L and hyperkalemia ≥5.0 mEq/L at the time of hospital admission were associated with higher one-year mortality.

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Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: A systematic review and meta-analysis

Cited by 28 publications

References 39 publications

Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis

Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis

Hypokalemia-Induced Arrhythmias and Heart Failure: New Insights and Implications for Therapy

Admission Serum Potassium Levels in Hospitalized Patients and One-Year Mortality

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