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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.
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