Abstract
Objectives
Serum levels of potassium (K+) appear to be significantly lower in severe cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the clinical significance of this is unknown. The objective was to investigate whether hypokalemia acts as a biomarker of severity in coronavirus disease 2019 (COVID-19) pneumonia and is associated with major clinical outcomes.
Methods
A retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 to May 2, 2020) was performed. Patients were categorized according to nadir levels of K+ in the first 72 h of admission: hypokalemia (K+ ≤3.5 mmol/l) and normokalemia (K+ >3.5 mmol/l). The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV); these were analyzed by multiple logistic regression (odds ratio (OR), 95% confidence interval (CI)).
Results
Three hundred and six patients were enrolled. Ninety-four patients (30.7%) had hypokalemia and these patients showed significantly higher comorbidity (Charlson comorbidity index ≥3, 30.0% vs 16.3%; p = 0.02) and CURB65 scores (median (interquartile range): 1.5 (0.0–3.0) vs 1.0 (0.0–2.0); p = 0.04), as well as higher levels of some inflammatory parameters at baseline. After adjustment for confounders, hypokalemia was independently associated with requiring IMV during the admission (OR 8.98, 95% CI 2.54–31.74). Mortality was 15.0% (n = 46) and was not influenced by low K+. Hypokalemia was associated with longer hospital and ICU stays.
Conclusions
Hypokalemia is prevalent in patients with COVID-19 pneumonia. Hypokalemia is an independent predictor of IMV requirement and seems to be a sensitive biomarker of severe progression of COVID-19.
【저자키워드】 Mortality, mechanical ventilation, cohort study, hypokalemia, COVID19 pneumonia, 【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, coronavirus, Biomarker, Pneumonia, severity, hospital, Infection, Comorbidity, progression, outcome, clinical outcomes, ICU, Patient, Logistic regression, Potassium, Admission, Invasive mechanical ventilation, Odds ratio, Inpatient, retrospective cohort study, acute respiratory syndrome, 95% CI, 95% confidence interval, all-cause mortality, confounders, Severe case, significantly lower, objective, IMV, independent, prevalent, Result, enrolled, analyzed, was performed, median, significantly higher, baseline, CURB65, inflammatory parameter, interquartile, patients with COVID-19, with COVID-19, 【제목키워드】 COVID-19, Biomarker, disease severity, Patient, Invasive mechanical ventilation, case sery,