Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Participants
2.3. Data Collection and Outcome Measures
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Original Cohort | Propensity-Matched Cohort | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Replacement (n = 1561) | No Replacement (n = 370) | STD | Replacement (n = 362) | No Replacement (n = 362) | STD | |||||
n | (%) | n | (%) | n | (%) | n | (%) | |||
Baseline characteristics | ||||||||||
Age (years), mean ± SD | 55.6 | ±20.0 | 46.0 | ±20.1 | +0.478 | 46.8 | ±20.1 | 46.3 | ±20.1 | +0.026 |
Male gender | 899 | 57.6 | 228 | 61.6 | −0.082 | 223 | 61.6 | 226 | 62.4 | −0.017 |
Time on ED arrival | −0.020 | +0.003 | ||||||||
08:01–16:00 | 348 | 22.3 | 122 | 33.0 | 112 | 30.9 | 117 | 32.3 | ||
16:01–24:00 | 597 | 38.2 | 122 | 33.0 | 129 | 35.6 | 120 | 33.2 | ||
00:01–08:00 | 616 | 39.5 | 126 | 34.0 | 121 | 33.4 | 125 | 34.5 | ||
Insurance | −0.141 | −0.028 | ||||||||
Universal coverage scheme | 673 | 43.1 | 163 | 44.1 | 170 | 47.0 | 158 | 43.7 | ||
Government officer | 317 | 20.3 | 53 | 14.3 | 57 | 15.8 | 53 | 14.6 | ||
Social security scheme | 144 | 9.2 | 41 | 11.1 | 42 | 11.6 | 39 | 10.8 | ||
Cash payment | 368 | 23.6 | 94 | 25.4 | 67 | 18.5 | 94 | 26.0 | ||
Stateless people | 59 | 3.8 | 19 | 5.1 | 26 | 7.2 | 18 | 5.0 | ||
Comorbidities | ||||||||||
Diabetes | 190 | 12.2 | 31 | 8.4 | +0.125 | 28 | 7.7 | 30 | 8.3 | −0.020 |
Chronic heart failure | 10 | 0.6 | 5 | 1.4 | +0.476 | 8 | 2.2 | 4 | 1.1 | +0.087 |
Chronic kidney disease | 144 | 9.2 | 25 | 6.8 | +0.091 | 28 | 7.7 | 24 | 6.6 | +0.043 |
Route of potassium replacement | N/A | N/A | ||||||||
Oral | 1253 | 80.3 | 0 | 0 | 257 | 71.0 | 0 | 0 | ||
Intravenous | 738 | 47.3 | 0 | 0 | 180 | 49.7 | 0 | 0 | ||
Serum potassium level (mmol/L), mean ± SD | 3.23 | ±0.14 | 3.31 | ±0.12 | −0.607 | 3.30 | ±0.11 | 3.31 | ±0.12 | −0.070 |
Serum creatinine level (mg/L), median (IQR) | 0.86 | (0.68–1.16) | 0.87 | (0.69–1.09) | +0.027 | 0.85 | (0.68–1.11) | 0.87 | (0.68–1.09) | +0.011 |
ED length of stay (hours), median (IQR) | 3.8 | (2.4–5.4) | 3.0 | (2.0–4.7) | +0.353 | 2.8 | (1.9–4.4) | 3.0 | (2.1–4.5) | −0.033 |
Hospital Characteristics | ||||||||||
Hospital length of stay (days), median (IQR) | 7 | (4–15) | 4 | (2–8) | +0.445 | 7 | (4–14) | 4 | (2–8) | +0.464 |
Hospital length of stay | +0.118 | +0.186 | ||||||||
<7 days | 875 | 56.1 | 225 | 60.8 | 192 | 53.0 | 220 | 60.8 | ||
7–30 days | 583 | 37.4 | 129 | 34.9 | 141 | 39.0 | 126 | 34.8 | ||
>30 days | 103 | 6.6 | 16 | 4.3 | 29 | 8.0 | 16 | 4.4 | ||
Acute comorbidities | ||||||||||
Sepsis | 57 | 3.7 | 10 | 2.7 | +0.054 | 17 | 4.7 | 10 | 2.8 | +0.102 |
Acute heart failure | 74 | 4.7 | 11 | 3.0 | +0.092 | 16 | 4.4 | 10 | 2.8 | +0.089 |
Propensity score, mean ± SD | 0.83 | ±0.12 | 0.72 | ±0.15 | +0.872 | 0.72 | ±0.14 | 0.72 | ±0.14 | +0.041 |
Equation Parameters | Coefficient | Standard Error | 95% Confidence Interval | p-Value |
---|---|---|---|---|
Age (year) | 0.022 | 0.003 | 0.015, 0.029 | <0.001 |
Male gender | 0.079 | 0.130 | −0.175, 0.334 | 0.542 |
Time on ED arrival | 0.207 | 0.078 | 0.055, 0.359 | 0.008 |
Insurance | −0.049 | 0.034 | −0.117, −0.019 | 0.160 |
Comorbidities | ||||
Diabetes | 0.048 | 0.236 | −0.414, 0.509 | 0.840 |
Chronic heart failure | −1.364 | 0.603 | −2.547, −0.182 | 0.024 |
Chronic kidney disease | −0.016 | 0.312 | −0.628, 0.596 | 0.959 |
Serum potassium level (mEq/L), mean ± SD | −0.525 | 0.053 | −0.630, −0.421 | <0.001 |
Serum creatinine level (mg/L), median (IQR) | −0.080 | 0.061 | −0.199, 0.040 | 0.192 |
ED length of stay (hours), median (IQR) | 0.135 | 0.320 | 0.073, 0.198 | <0.001 |
Clinical Outcome | Replacement (n = 362) | No Replacement (n = 362) | Treatment Effect (Potassium Replacement vs. No Replacement at ED) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | Parameter | Unadjusted Analysis | Adjusted Analysis † | |||||
Effect | 95% CI | p-Value | Effect | 95% CI | p-Value | ||||||
All-cause hospital mortality | 12 | 3.3 | 14 | 3.9 | Odds ratio | 0.85 | 0.39, 1.87 | 0.69 | 0.81 | 0.36, 1.79 | 0.60 |
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Wongtanasarasin, W.; Meelarp, N. Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis. Medicina 2023, 59, 1912. https://doi.org/10.3390/medicina59111912
Wongtanasarasin W, Meelarp N. Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis. Medicina. 2023; 59(11):1912. https://doi.org/10.3390/medicina59111912
Chicago/Turabian StyleWongtanasarasin, Wachira, and Nattikarn Meelarp. 2023. "Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis" Medicina 59, no. 11: 1912. https://doi.org/10.3390/medicina59111912