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Inicio Medicina Clínica (English Edition) Prognostic implications of hypo and hyperkalaemia in acute heart failure with re...
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Vol. 158. Issue 5.
Pages 211-217 (March 2022)
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Vol. 158. Issue 5.
Pages 211-217 (March 2022)
Original article
Prognostic implications of hypo and hyperkalaemia in acute heart failure with reduced ejection fraction. Analysis of cardiovascular mortality and hospital readmissions
Implicaciones pronósticas de la hipo e hiperpotasemia en la insuficiencia cardíaca aguda con fracción de eyección reducida. Análisis de la mortalidad cardiovascular y reingresos hospitalarios
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Rocío del Pilar Laymito-Quispea,b,
Corresponding author
chiolaymito@yahoo.es

Corresponding author.
, Raquel López-Vilellaa,b, Ignacio Sánchez-Lázaroa,b,c, Víctor Donoso-Trenadoa,b, Silvia Lozano-Edoa,b, Luis Martínez-Dolzb,d, Luis Almenar-Boneta,b,c,d
a Unidad de Insuficiencia Cardíaca y Trasplante, Hospital Universitari i Politècnic La Fe, Valencia, Spain
b Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
c Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Valencia, Spain
d Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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Figures (2)
Tables (4)
Table 1. Clinical and epidemiological characteristics of the population according to their potassium levels.
Table 2. Probability of survival and readmissions at one year according to potassium levels.
Table 3. Mortality and hospital readmission rate according to potassium levels.
Table 4. Multivariate analysis adjusted for significant variables according to potassium levels.
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Abstract
Background and objectives

Potassium alterations constitute a major clinical problem in decompensated heart failure (HF). This study aims to assess the prognostic implications of hypo and hyperkalaemia on admission for acute HF in cardiovascular mortality and hospital readmissions.

Material and method

From January 2016 to June 2020, 1,397 cases with a diagnosis of acute HF were admitted. Admission programmed for study, elective therapies, and patients with LVEF >40% were excluded. The study was carried out on 689 patients, 45 with K+ <3.5 mmol/l, 49 K+ >5.0 mmol/l and 595 K+ 3.5–5.0 mmol/l. Medical history, baseline clinical profile, drug therapy, and potassium levels obtained upon admission were analysed.

Results

Annual mortality due to hypokalaemia (K+ <3.5 mmol/l) was 37.8% (HR 2.4: 95%CI 1.3−4.7; p < 0.007); for hyperkalaemia 40.8% (HR 1.9: 95% CI: 0.98−3.51; p < 0.055). Creatinine level and age were variables associated with mortality in both the hyperkalaemic and hypokalaemic cohorts. Hospital readmissions did not show statistical association with these electrolyte disorders.

Conclusions

In patients admitted for decompensated HF, both hyperkalaemia and hypokalaemia determined at admission have a negative prognostic impact on survival. Creatinine and age are other independent factors associated with mortality. The effect on the probability of hospital readmission at one year is not demonstrated in this study.

Keywords:
Hyperkalaemia
Hypokalaemia
Hospital admission
Acute heart failure
Prognosis
Resumen
Antecedentes y objetivos

Las alteraciones del potasio constituyen un problema clínico de gran magnitud en la insuficiencia cardíaca (IC) descompensada. Este estudio pretende valorar las implicaciones pronósticas de la hipo e hiperpotasemia al ingreso por IC aguda en la mortalidad cardiovascular y reingresos hospitalarios.

Material y método

De enero del 2016 a junio del 2020 fueron ingresados 1.397 casos con diagnóstico de IC aguda. Se excluyeron ingresos programados para estudio, terapias electivas y pacientes con fracción de eyección del ventrículo izquierdo (FEVI) >40%. El estudio se realizó sobre 689 pacientes, 45 con potasio (K+) <3,5 mmol/l, 49 K+ >5,0 mmol/l y 595 K+ 3,5−5,0 mmol/l. Se analizaron los antecedentes, perfil clínico basal, terapia farmacológica y niveles de potasio obtenidos al ingreso.

Resultados

La mortalidad anual por hipopotasemia (K+ < de 3,5 mmol/l) fue 37,8% (HR 2,4: IC95% 1,3–4,7; p < 0,007); para hiperpotasemia de 40,8% (HR 1,9: IC95%: 0,98−3,51; p < 0,055). El nivel de creatinina y la edad fueron variables asociadas a mortalidad, tanto en la cohorte de hiperpotasemia como en la de hipopotasemia. Los reingresos hospitalarios no mostraron asociación estadística con estos trastornos electrolíticos.

Conclusiones

En los pacientes ingresados por IC descompensada, tanto la hiperpotasemia como la hipopotasemia determinadas al ingreso, tienen impacto pronóstico negativo en la supervivencia. La creatinina y la edad son otros factores independientes asociados a mortalidad. El efecto sobre la probabilidad de reingreso hospitalario al año no se demuestra en este trabajo.

Palabras clave:
Hiperpotasemia
Hipopotasemia
Ingreso hospitalario
Insuficiencia cardíaca aguda
Pronóstico

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