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Table 4 Association between in-hospital mortality and clinical factors

From: Severe hyperkalemia requiring hospitalization: predictors of mortality

  Number (percentage) unless indicated otherwise Univariate analysis Multiple logistic regression analysisa
  In-hospital mortality group Survival group OR (95% CI) P OR (95% CI) P
Modifiable factors       
Serum K level, mEq/Lb 7.3 ± 0.9 7.0 ± 0.6 1.66 (1.37-2.00) < 0.001   
Serum K level, mEq/Lb 2.2 ± 1.5 1.1 ± 1.3 1.70 (1.53-1.89) < 0.001 1.83 (1.52-2.20) < 0.001
Coexisting medical conditionsc       
   New-onset AKI 120 (42.4) 79 (12.3) 5.23 (3.75-7.30) < 0.001 2.17 (1.27-3.71) 0.005
   AKI on CKD 117 (41.3) 366 (57.2) 0.53 (0.40-0.70) < 0.001   
Infection 155 (54.8) 149 (23.3) 3.99 (2.96-5.37) < 0.001 2.07 (1.27-3.38) 0.004
Volume depletion 165 (58.3) 261 (40.8) 2.03 (1.53-2.70) < 0.001   
Bleeding 108 (38.2) 65 (10.2) 5.46 (3.84-7.76) < 0.001 4.56 (2.61-7.98) < 0.001
   Rhabdomyolysis 39 (13.8) 13 (2.0) 7.71 (4.05-14.69) < 0.001   
   Tumor lysis syndrome 9 (3.2) 2 (0.3) 10.48 (2.25-48.81) 0.003   
   Poor compliance 4 (1.4) 26 (4.1) 0.34 (0.12-0.98) 0.046   
   Constipation 2 (0.7) 5 (0.8) 0.90 (0.17-4.69) 0.904   
   Transfusion 12 (4.2) 12 (1.9) 2.32 (1.03-5.22) 0.043   
   Adrenal insufficiency 4 (1.4) 12 (1.9) 0.75 (0.24-2.35) 0.621   
CPR       
   No indication 22 (7.8) 609 (95.2) Reference    
   Due to hyperkalemia 47 (16.6) 13 (2.0) 100.1 (47.4-211.3) < 0.001   
   Due to other causes 214 (75.6) 18 (2.8) 329.1 (173.2- 625.5) < 0.001   
ICU treatment       
   No indication 83 (29.3) 518 (80.9) Reference   Reference  
   Need for ICU care 80 (28.3) 46 (7.2) 10.85 (7.06-16.69) < 0.001 3.62 (1.79-7.32) < 0.001
   During ICU care 120 (42.4) 76 (11.9) 9.85 (6.81-14.25) < 0.001 2.98 (1.69-5.24) < 0.001
Level of support Ib 2.4 ± 1.5 2.7 ± 1.8 0.91 (0.84-0.99) 0.020   
Level of support IIb 2.9 ± 1.9 3.0 ± 1.9 0.96 (0.89-1.03) 0.266   
Improvement in hyperkalemiac 132 (46.6) 583 (91.1) 0.09 (0.06-0.12) < 0.001   
Non-modifiable factors       
Male gender 199 (70.3) 387 (60.5) 1.55 (1.15-2.09) 0.004   
Age, yearsb 60.6 ± 15.5 61.3 ± 14.7 1.00 (0.99 - 1.01) 0.502   
Underlying diseasesc       
   Diabetes mellitus 82 (29.0) 293 (45.8) 0.48 (0.36-0.65) < 0.001   
   Hypertension 90 (31.8) 337 (52.7) 0.42 (0.31-0.56) < 0.001   
   Chronic kidney disease (CKD)       
No CKD + stage I 139 (49.3) 136 (21.6) Reference    
Stage II 55 (19.5) 103 (16.3) 0.52 (0.35-0.78) 0.002   
Stage III 50 (17.7) 157 (24.9) 0.31 (0.21-0.46) < 0.001   
Stage IV 9 (3.2) 70 (11.1) 0.13 (0.06-0.26) < 0.001   
Stage V 29 (10.3) 165 (26.1) 0.17 (0.11-0.27) < 0.001   
   Malignancy 114 (40.3) 185 (28.9) 1.66 (1.24-2.22) 0.001 2.88 (1.68-4.96) < 0.001
   Liver cirrhosis 55 (19.4) 106 (16.6) 1.21 (0.85-1.74) 0.290   
   CHF 24 (8.5) 47 (7.3) 1.16 (0.69-1.94) 0.583   
   Arrhythmia       
Atrial fibrillation 37 (13.1) 63 (9.8) 1.39 (0.90-2.14) 0.141   
SSS, 1' AV block 9 (3.2) 18 (2.8) 1.18 (0.52-2.66) 0.691   
   Thyroid disease 11 (3.9) 27 (4.2) 0.92 (0.45-1.87) 0.815   
   Coronary artery disease 31 (11.0) 77 (12.0) 0.91 (0.58-1.42) 0.682   
   Pulmonary disease 33 (11.7) 62 (9.7) 1.23 (0.79-1.93) 0.364   
   Cerebrovascular disease 26 (9.2) 69 (10.8) 0.84 (0.52-1.35) 0.463   
   History of recur 6 (2.1) 56 (8.8) 0.23 (0.10-0.53) 0.001   
The type of admission       
   Planned admission 38 (13.4) 252 (39.4) Reference   Reference  
   Emergent admission 245 (86.6) 388 (60.6) 4.19 (2.87-6.10) < 0.001 2.97 (1.56-5.66) 0.001
Onset of hyperkalemia       
   On admission 69 (24.4) 300 (46.9) Reference    
   During admission 214 (75.6) 340 (53.1) 2.74 (2.00-3.74) < 0.001   
Location at diagnosis with hyperkalemia       
   Emergency room 68 (24.0) 182 (28.4) Reference    
   ICU 118 (41.7) 74 (11.6) 4.27 (2.85-6.38) < 0.001   
   Surgical ward 11 (3.9) 138 (21.6) 0.21 (0.11-0.42) < 0.001   
   Medical ward 86 (30.4) 246 (38.4) 0.94 (0.65-1.36) 0.726   
MOF at admissionc 71 (25.1) 37 (5.8) 5.46 (3.56-8.37) < 0.001   
MOF at diagnosisc 194 (68.6) 32 (5.0) 41.42 (26.80-63.99) < 0.001 7.64 (4.00-14.57) < 0.001
Diagnosis at arrestc 166 (58.7) 21 (3.3) 41.82 (25.49-68.61) < 0.001   
Symptoms pertinent to hyperkalemia       
   Asymptomatic 77 (27.2) 414 (64.5) Reference   Reference  
   Cardiac arrest 166 (58.7) 21 (3.4) 42.96 (25.65-71.94) < 0.001 8.84 (4.18-18.68) < 0.001
   Arrhythmia 30 (10.6) 122 (19.1) 1.50 (0.94-2.40) 0.087 1.24 (0.63-2.43) 0.533
   Other symptoms 10 (3.5) 83 (13.0) 0.58 (0.29-1.16) 0.123 0.64 (0.26-1.59) 0.338
  1. aCovariables: gender, age, serum K+ level, the differences between the admission and highest serum K+ levels, diabetes mellitus, hypertension, malignancy, history of recurrence, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, beta blocker, K+-sparing diuretics, non-steroidal anti-inflammatory drugs, infection, volume depletion, bleeding, poor compliance, transfusion, new-onset acute kidney injury (AKI), AKI on chronic kidney disease, multi-organ failure (MOF) at the time of diagnosis, the type of admission, onset of hyperkalemia, symptoms pertinent to hyperkalemia, level of support I, and intensive care unit (ICU) treatment. bMean ± standard deviation. cThe following were entered as 'yes-no' variables: underlying diseases; coexisting medical conditions; drug-induced hyperkalemia; potassium supplements; the presence of multiple organ failure at admission or at hyperkalemia diagnosis; hyperkalemia diagnosis at the time of cardiac arrest; and improvement in hyperkalemia. The frequency, proportion, and odds ratios (ORs) of these variables were determined by comparing 'yes' variables to the 'no' variables. AV, atrioventricular; CHF, congestive heart failure; CI, confidence interval; CPR, cardiopulmonary resuscitation; SSS, sick sinus syndrome.