Risk of respiratory failure among hospitalized patients with various admission serum potassium levels

Cheungpasitporn, Wisit; Chewcharat, Api; Mao, Michael A; Vallabhajosyula, Saraschandra; Thirunavukkarasu, Sorkko; Kashani, Kianoush

doi:10.1080/21548331.2020.1729621

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…In addition, the data from this study were retrieved from institutional database. Unfortunately, some clinical information such as treatment of abnormalities of calcium derangements, oral calcium supplement, intravenous calcium infusion, complete data on other electrolytes [41][42][43][44][45][46], and medications was not available in our database and, therefore, was not reported in this study. Although we extensively adjusted for potential confounders, the association between serum calcium change and mortality might remain be confounded by unmeasured confounders.…”

Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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Background and objectives: Calcium concentration is strictly regulated at both the cellular and systemic level, and changes in serum calcium levels can alter various physiological functions in various organs. This study aimed to assess the association between changes in calcium levels during hospitalization and mortality. Materials and Methods: We searched our patient database to identify all adult patients admitted to our hospital from January 1st, 2009 to December 31st, 2013. Patients with ≥2 serum calcium measurements during the hospitalization were included. The serum calcium changes during the hospitalization, defined as the absolute difference between the maximum and the minimum calcium levels, were categorized into five groups: 0–0.4, 0.5–0.9, 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL. Multivariable logistic regression was performed to assess the independent association between calcium changes and in-hospital mortality, using the change in calcium category of 0–0.4 mg/dL as the reference group. Results: Of 9868 patients included in analysis, 540 (5.4%) died during hospitalization. The in-hospital mortality progressively increased with higher calcium changes, from 3.4% in the group of 0–0.4 mg/dL to 14.5% in the group of ≥2.0 mg/dL (p < 0.001). When adjusted for age, sex, race, principal diagnosis, comorbidity, kidney function, acute kidney injury, number of measurements of serum calcium, and hospital length of stay, the serum calcium changes of 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL were significantly associated with increased in-hospital mortality with odds ratio (OR) of 1.55 (95% confidence interval (CI) 1.15–2.10), 1.90 (95% CI 1.32–2.74), and 3.23 (95% CI 2.39–4.38), respectively. The association remained statistically significant when further adjusted for either the lowest or highest serum calcium. Conclusion: Larger serum calcium changes in hospitalized patients were progressively associated with increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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“…Potassium is a vital mineral that plays a versatile role in numerous cellular and enzymatic functions [1,2]. Plasma levels are normally maintained within a narrow range, measured at our institution from 3.5 to 5.2 mEq/L [2][3][4][5].…”

Section: Introductionmentioning

confidence: 91%

Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

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Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤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. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L.

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“…[16][17][18][19][20][21][22] Previously, we identified several electrolyte derangements at the time of hospital admission as risk factors for ARF in hospitalised patients. These risk factors included hypophosphataemia or hyperphosphataemia, 20 low serum creatinine, 21 hypoalbuminaemia, 23 hypokalaemia or hyperkalaemia 24 Open access and hypomagnesaemia or hypermagnesaemia. 25 Alterations of serum calcium have been linked to the development of ARF in several case reports.…”

Section: Introductionmentioning

confidence: 99%

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

et al. 2020

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ObjectivesThe objective of this study was to evaluate the risk of acute respiratory failure in all hospitalised patients based on admission serum ionised calcium.DesignA retrospective cohort study.SettingA tertiary referral hospital in Rochester, Minnesota, USA.ParticipantsAll hospitalised patients who had serum ionised calcium measurement within 24 hours of hospital admission from January 2009 to December 2013. Patients who were mechanically ventilated at admission were excluded.PredictorsAdmission serum ionised calcium levels was stratified into six groups: ≤4.39, 4.40–4.59, 4.60–4.79, 4.80–4.99, 5.00–5.19 and ≥5.20 mg/dL.Primary outcome measureThe primary outcome was the development of acute respiratory failure requiring mechanical ventilation during hospitalisation. Logistic regression analysis was fit to assess the independent risk of acute respiratory failure based on various admission serum ionised calcium, using serum ionised calcium of 5.00–5.19 mg/dL as the reference group.ResultsOf 25 709 eligible patients, with the mean serum ionised calcium of 4.8±0.4 mg/dL, acute respiratory failure requiring mechanical ventilation occurred in 2563 patients (10%). The incidence of acute respiratory failure was lowest when admission serum ionised calcium was 5.00–5.19 mg/dL, with the progressively increased risk of acute respiratory failure with decreased serum ionised calcium. In multivariate analysis with adjustment for potential confounders, the increased risk of acute respiratory failure requiring mechanical ventilation was significantly associated with admission serum ionised calcium of ≤4.39 (OR 2.52; 95% CI 2.12 to 3.00), 4.40–4.59 (OR 1.76; 95% CI 1.49 to 2.07) and 4.60–4.79 mg/dL (OR 1.48; 95% CI 1.27 to 1.72), compared with serum ionised calcium of 5.00–5.19 mg/dL. The risk of acute respiratory failure was not significantly increased when serum ionised calcium was at least 4.80 mg/dL.ConclusionThe increased risk of acute respiratory failure requiring mechanical ventilation was observed when admission serum ionised calcium was lower than 4.80 mg/dL in hospitalised patients.

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Risk of respiratory failure among hospitalized patients with various admission serum potassium levels

Cited by 11 publications

References 27 publications

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

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