Scholarlink

Introduction <p>Piperacillin/tazobactam (TZP) is widely used in hospitalised adults. Real‑world data suggest a higher risk of hypokalaemia than previously recognised.</p> Aim <p>To investigate incidence, severity and risk factors of TZP‑induced hypokalaemia, and to develop and externally validate a nomogram for individualised risk prediction.</p> Method <p>This retrospective study included hospitalised adults receiving TZP (2021–2025). TZP‑induced hypokalaemia was defined as serum potassium &lt; 3.5&#xa0;mmol/L ≥ 48&#xa0;h after TZP initiation. Logistic regression identified predictors. A nomogram was constructed. Model performance was assessed by discrimination (area under the ROC curve, AUC), calibration (Hosmer‑Lemeshow test, calibration intercept/slope), Brier score and decision‑curve analysis (DCA), with internal and external validation.</p> Results <p>Among 643 patients, 122 (19.0%) developed TZP‑induced hypokalaemia (mild: 78.7%; moderate: 16.4%; severe: 4.9%). Median time to onset was 5.0&#xa0;days. Independent predictors were age ≥ 65&#xa0;years (OR = 2.118, 95% CI 1.003–4.472, <i>p</i> = 0.049), body mass index (OR = 0.671, 95% CI 0.591–0.762, <i>p</i> &lt; 0.001), intensive care unit admission (OR = 2.915, 95% CI 1.504–5.651, <i>p</i> = 0.002), daily dose (OR = 1.280, 95% CI 1.110–1.476, <i>p</i> &lt; 0.001), and baseline serum potassium (OR = 0.123, 95% CI 0.056–0.271, <i>p</i> &lt; 0.001). The nomogram showed good discrimination (training AUC 0.881, internal 0.876, external 0.813), calibration (Hosmer‑Lemeshow <i>p</i> &gt; 0.05), Brier scores &lt; 0.25 and positive net benefit on DCA.</p> Conclusion <p>TZP‑induced hypokalaemia is common in hospitalised adults. A nomogram based on five readily available clinical variables may facilitate early identification of high‑risk patients, although prospective validation in diverse settings is required before clinical implementation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Active surveillance and risk prediction of piperacillin/tazobactam‑associated hypokalaemia: development and external validation of a clinical nomogram

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月24日

查看全文
  • Hehe Bai,
  • Miao Guo,
  • Nanbo Zheng,
  • Xiaojing Nie

摘要

Introduction

Piperacillin/tazobactam (TZP) is widely used in hospitalised adults. Real‑world data suggest a higher risk of hypokalaemia than previously recognised.

Aim

To investigate incidence, severity and risk factors of TZP‑induced hypokalaemia, and to develop and externally validate a nomogram for individualised risk prediction.

Method

This retrospective study included hospitalised adults receiving TZP (2021–2025). TZP‑induced hypokalaemia was defined as serum potassium < 3.5 mmol/L ≥ 48 h after TZP initiation. Logistic regression identified predictors. A nomogram was constructed. Model performance was assessed by discrimination (area under the ROC curve, AUC), calibration (Hosmer‑Lemeshow test, calibration intercept/slope), Brier score and decision‑curve analysis (DCA), with internal and external validation.

Results

Among 643 patients, 122 (19.0%) developed TZP‑induced hypokalaemia (mild: 78.7%; moderate: 16.4%; severe: 4.9%). Median time to onset was 5.0 days. Independent predictors were age ≥ 65 years (OR = 2.118, 95% CI 1.003–4.472, p = 0.049), body mass index (OR = 0.671, 95% CI 0.591–0.762, p < 0.001), intensive care unit admission (OR = 2.915, 95% CI 1.504–5.651, p = 0.002), daily dose (OR = 1.280, 95% CI 1.110–1.476, p < 0.001), and baseline serum potassium (OR = 0.123, 95% CI 0.056–0.271, p < 0.001). The nomogram showed good discrimination (training AUC 0.881, internal 0.876, external 0.813), calibration (Hosmer‑Lemeshow p > 0.05), Brier scores < 0.25 and positive net benefit on DCA.

Conclusion

TZP‑induced hypokalaemia is common in hospitalised adults. A nomogram based on five readily available clinical variables may facilitate early identification of high‑risk patients, although prospective validation in diverse settings is required before clinical implementation.