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Background <p>It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.</p> Methods <p>We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: &lt; 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, &gt; 6.0&#xa0;mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6&#xa0;mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.</p> Results <p>Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5&#xa0;mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0&#xa0;mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); &gt; 6.0&#xa0;mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.</p> Conclusions <p>In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival.</p>

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The association between arrival potassium and 30-day survival following resuscitation from out-of-hospital cardiac arrest: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月26日

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  • Christina Byrne,
  • Maria Lukacs Krogager,
  • Kristian Kragholm,
  • Manan Pareek,
  • Grimur Høgnason Mohr,
  • Kristian Bundgaard Ringgren,
  • Mads Wissenberg,
  • Signe Riddersholm,
  • Martin Wolder,
  • Fredrik Folke,
  • Gunnar Gislason,
  • Lars Køber,
  • Christian Hassager,
  • Jesper Kjærgaard,
  • Christopher B. Fordyce,
  • Christian Torp-Pedersen,
  • Gregory Y. H. Lip,
  • Carlo A. Barcella

摘要

Background

It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.

Methods

We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.

Results

Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.

Conclusions

In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival.