PDF(Pubmed)
Abstract：
Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the \'hidden\' human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017-Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5-5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5-5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.
摘要：
高钾血症与住院时间延长和死亡率恶化有关。高钾血症也可能需要临床咨询，治疗高钾血症和高依赖性床利用。我们评估了住院患者高钾血症的“隐藏”人力和组织资源利用率。这是一个单一的中心，观察性队列研究（2017年1月至2020年12月），在一家三级医院进行。CogStack系统（数据处理和分析平台）用于从单个患者记录中搜索非结构化和结构化数据。使用三次样条回归对钾和死亡之间的关系进行建模，根据年龄调整，性别,和合并症。Cox比例风险估计了与正常钾血症（3.5-5.0mmol/l）相比的死亡风险。129,172名患者在急诊科进行了钾测量。高钾血症的发病率为85.7/1000。有49,011例紧急入院。钾>6.5mmol/L的住院死亡率比正常钾血症低3.9倍。慢性肾脏疾病的发生率为21％，钾含量为5-5.5mmol/L，钾含量为54％，钾含量>6.5mmol/L。对于糖尿病，它是20%和32%，分别。那些钾>6.5mmol/L,29%的人有肾病检查,和13％的重症监护审查；在该组中，22％转移到肾脏病房，8％转移到重症监护病房。在峰值钾>6.5mmol/L的患者中，有39％使用透析。入院高钾血症和低钾血症与出院可能性降低独立相关。高钾血症与更高的住院死亡率和降低的出院可能性相关。它需要大量利用肾脏病学和重症监护咨询，并有更大的可能性将患者转移到肾脏和重症监护。
