Serum Potassium Levels and Outcome in Acute Heart Failure (Data from the PROTECT and COACH Trials)

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• 作者：Jasper Tromp ; MD^a ; Jozine M. ter Maaten ; MD^a ; Kevin Damman ; MD^a ; Christopher M. O'Connor ; MD^b ; Marco Metra ; MD^c ; Howard C. Dittrich ; MD^d ; Piotr Ponikowski ; MD^e ; John R. Teerlink ; MD^f ; Gad Cotter ; MD^g ; Beth Davison ; PhD^g ; John G.F. Cleland ; MD^h ; Michael M. Givertz ; MDⁱ ; Daniel M. Bloomfield ; MD^j ; Martje H.L. van der Wal ; RN ; PhD^a ; ^k ; Tiny Jaarsma ; RN ; PhD^k ; Dirk J. van Veldhuisen ; MD^a ; Hans L. Hillege ; MD ; PhD^a ; ^l ; Adriaan A. Voors ; MD^a ; Peter van der Meer ; MD^a ; ^{p.van.der.meer@umcg.nl}
• 刊名：The American Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：119
• 期：2
• 页码：290-296
• 全文大小：600 K
• 卷排序：119

文摘

Serum potassium is routinely measured at admission for acute heart failure (AHF), but information on association with clinical variables and prognosis is limited. Potassium measurements at admission were available in 1,867 patients with AHF in the original cohort of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients were grouped according to low potassium (<3.5 mEq/l), normal potassium (3.5 to 5.0 mEq/l), and high potassium (>5.0 mEq/l) levels. Results were verified in a validation cohort of 1,023 patients. Mean age of patients was 71 ± 11 years, and 66% were men. Low potassium was present in 115 patients (6%), normal potassium in 1,576 (84%), and high potassium in 176 (9%). Potassium levels increased during hospitalization (0.18 ± 0.69 mEq/l). Patients with high potassium more often used angiotensin-converting enzyme inhibitors and mineralocorticoid receptor antagonists before admission, had impaired baseline renal function and a better diuretic response (p = 0.005), independent of mineralocorticoid receptor antagonist usage. During 180-day follow-up, a total of 330 patients (18%) died. Potassium levels at admission showed a univariate linear association with mortality (hazard ratio [log] 2.36, 95% confidence interval 1.07 to 5.23; p = 0.034) but not after multivariate adjustment. Changes of potassium levels during hospitalization or potassium levels at discharge were not associated with outcome after multivariate analysis. Results in the validation cohort were similar to the index cohort. In conclusion, high potassium levels at admission are associated with an impaired renal function but a better diuretic response. Changes in potassium levels are common, and overall levels increase during hospitalization. In conclusion, potassium levels at admission or its change during hospitalization are not associated with mortality after multivariate adjustment.