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血钾水平对老年脓毒症患者预后的影响

Effects of serum potassium levels on prognosis in elderly patients with sepsis

    摘要
  • 摘要:
    目的 探讨血钾水平对老年脓毒症患者28 d预后的影响。
    方法 回顾性分析2018年1月至2022年1月在复旦大学附属中山医院重症医学科住院的204例老年脓毒症患者的临床资料及确诊脓毒症24 h内的实验室指标。依据患者入住重症监护室（intensive care unit, ICU） 24 h内血液中钾离子浓度，将患者分为高钾血症组（K＋≥5.3 mmol/L）、正常血钾组（K＋ 3.5～＜5.3 mmol/L）、低钾血症组（K＋＜3.5 mmol/L）。依据28 d预后，将患者分为存活组和死亡组。分析各组患者急性生理学与慢性健康状况评分系统（acute physiological and chronic health evaluation, APACHE）Ⅱ、序贯器官衰竭评分（sequential organ failure assessment, SOFA）、实验室指标等。采用logistic回归分析老年脓毒症患者28 d死亡的危险因素。
    结果 高钾血症组（n＝61）与低钾血症组（n＝44）的C反应蛋白（C-reactive protein, CRP）、降钙素原（procalcitonin, PCT）水平高于正常血钾组（n＝99），机械通气时间、总住院时间、ICU住院时间长于正常血钾组，死亡率高于正常血钾组（P＜0.05）。死亡组（n＝49）的APACHE Ⅱ评分、SOFA评分、白细胞计数、CRP、PCT均高于存活组（n＝155，P＜0.05）。多因素logistic回归分析显示，血钾升高或降低、SOFA评分升高及白细胞计数增加是老年脓毒症患者28 d死亡的独立危险因素（P＜0.05）。二次拟合曲线显示，血钾水平与老年脓毒症患者28 d死亡风险呈U型关系，即血钾在中间范围（正常水平）时，患者死亡风险最低，低血钾和高血钾均可增加死亡风险（P＝0.182）。
    结论 血钾水平升高或降低是老年脓毒症患者28 d死亡的独立危险因素，临床管理中应予以重视。

     

    Abstract:
    Objective To explore the effects of different serum potassium levels on the 28-day prognosis of elderly patients with sepsis.
    Methods A retrospective analysis was conducted on the clinical data and laboratory indicators within 24 hours after the diagnosis in 204 elderly patients with sepsis admitted to the Department of Critical Care Medicine, Zhongshan Hospital, Fudan University from January 2018 to January 2022. According to the potassium concentrations in the blood of the patients within 24 hours after admission to intensive care unit (ICU), the patients were divided into the hyperkalemia group (K＋≥5.3 mmol/L), normokalemia group (K＋ 3.5–＜5.3 mmol/L), and hypokalemia group (K＋＜3.5 mmol/L). According to 28-day outcomes, the patients were divided into the death group and survival group. The acute physiological and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment (SOFA) score and laboratory indicators were analyzed. Multivariate logistic regression analysis was used to analyze the risk factors for 28-day mortality in elderly patients with sepsis.
    Results Compared with the normokalemia group (n＝99), patients in both the hyperkalemia (n＝61) and hypokalemia (n＝44) groups had significantly higher levels of C-reactive protein (CRP) and procalcitonin (PCT), longer duration of mechanical ventilation, longer length of hospital stay and ICU stay, and higher mortality (P ＜ 0.05). The death group (n＝49) had significantly higher APACHE Ⅱ score, SOFA score, white blood cell (WBC) counts, CRP level, and PCT level than the survival group (n＝155, P＜0.05). Multivariate logistic regression analysis showed that increased or decreased serum potassium level, higher SOFA score, and increased WBC counts were independent risk factors for 28-day mortality in elderly patients with sepsis (P＜0.05). Quadratic fitted curve showed a U-shaped association between serum potassium levels and 28-day mortality risk in elderly patients with sepsis, with the lowest mortality risk observed within the intermediate (normal) range, and both hypokalemia and hyperkalemia were associated with an increased mortality risk (P＝0.182).
    Conclusion Both increased and decreased serum potassium levels are independent risk factors for 28-day mortality in elderly patients with sepsis, which should be given particular attention in clinical management.

     

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