Hypokalemia as a sensitive biomarker of disease severity and the requirement for invasive mechanical ventilation requirement in COVID-19 pneumonia: A case series of 306 Mediterranean patients

Autor: Oscar Moreno-P, Jose-Manuel Leon-Ramirez, Laura Fuertes-Kenneally, Miguel Perdiguero, Mariano Andres, Mar Garcia-Navarro, Paloma Ruiz-Torregrosa, Vicente Boix, Joan Gil, Esperanza Merino, Santos Asensio, Cleofé Fernandez, Alfredo Candela, Mª del Mar García, Rosario Sánchez, Sergio Reus, Paloma Ruiz, Raquel García-Sevila, María-Ángeles Martínez, María-Mar García-Mullor, Mar Blanes, Jaime Guijarro, José Carlos Pascual, Iris Gonzalez, Pedro Sanso, José Manuel Ramos, Jaime Javaloy, Clara Llopis, Olga Coronado, Esther García, Gonzalo Rodríguez, Paola Melgar, Mariano Franco, Félix Lluís, Carmen Zaragoza, Cándido Alcaraz, Ana Carrión, Celia Villodre, Emilio Ruiz de la Cuesta, Cristina Alenda, Francisca Peiró, María Planelles, Laura Greco, Sandra Silvia, Antonio Francia, Iván Verdú, Juan Sales, Ana Palacios, Hortensia Ballester, Antonio García-Valentín, Marta Márquez, Eva Canelo, Andrea Juan, Elena Vives, Andrea Revert, Gonzalo Fuente, Ester Nofuentes, Carolina Mangas, Eva Vera, Alicia Ferradas, Helena López, Cristian Herrera, Beatriz López, Marina Morillas, Vanesa Rodríguez, Mercedes Khartabil, Mario Giménez, Ernesto Tovar, Estela Martínez, Lucia Medina, Sandra Baile, Carlos Salazar, Norma Guerra, Sarai Moliner, Mari-Carmen López-González, Blanca Figueres
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
endocrine system diseases
medicine.medical_treatment
urologic and male genital diseases
Severity of Illness Index
0302 clinical medicine
Interquartile range
030212 general & internal medicine
Aged
80 and over
General Medicine
Middle Aged
Hypokalemia
Infectious Diseases
Female
medicine.symptom
Coronavirus Infections
COVID19 pneumonia
Adult
Microbiology (medical)
medicine.medical_specialty
Pneumonia
Viral
030106 microbiology
mechanical ventilation
Article
lcsh:Infectious and parasitic diseases
Betacoronavirus
03 medical and health sciences
Internal medicine
Severity of illness
hypokalemia
cohort study
medicine
Humans
lcsh:RC109-216
Pandemics
Aged
Retrospective Studies
Mechanical ventilation
SARS-CoV-2
business.industry
COVID-19
nutritional and metabolic diseases
Retrospective cohort study
Odds ratio
medicine.disease
Respiration
Artificial
mortality
Comorbidity
Pneumonia
business
Biomarkers
Zdroj: International Journal of Infectious Diseases
International Journal of Infectious Diseases, Vol 100, Iss, Pp 449-454 (2020)
ISSN: 1201-9712
Popis: Highlights • There is a high prevalence of hypokalemia among patients with COVID-19 pneumonia. • This suggests the presence of a disorder in the renin-angiotensin system activity. • Hypokalemia is associated with requiring invasive mechanical ventilation. • Hypokalemia seems to be a sensitive biomarker of severity-progression of COVID-19. • Serum levels of potassium should be closely monitored in these patients.
Objectives Serum levels of potassium (K+) seem significantly lower in severe SARS-CoV-2 infection, with an unknown clinical translation. The objective was to investigate whether hypokalemia acts as a biomarker of severity in COVID-19 pneumonia, and associates with major clinical outcomes. Methods Retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 - May 2, 2020). Patients were categorized according to nadir levels of K + in the first 72 hours of admission: hypokalemia (K+ ≤3.5 mmol/L) and normokalemia (>3.5 mmol/L). Main outcomes were all-cause mortality and need of invasive mechanical ventilation (IMV), analyzed by multiple logistic regression (OR; 95%CI). Results 306 patients were enrolled. Ninety-four patients (30.7%) had hypokalemia, showing at baseline significantly higher comorbidity (Charlson index ≥3, 30.0% vs. 16.3%)(p = 0.02), CURB65 scores (1.5(0.0-3.0) vs. 1.0(0.0-2.0))(p = 0.04), and some inflammatory parameters. After adjustment for confounders, hypokalemia was independently associated with requiring IMV during the admission (OR 8.98; 95%CI 2.54-31.74). Mortality was 15.0% (n = 46) and was not influenced by low K + . Hypokalemia was associated with longer hospital and ICU stay. Conclusions Hypokalemia is prevalent in patients with COVID-19 pneumonia. Hypokalemia is an independent predictor of IMV requirement and seems to be a sensitive biomarker of severe progression of COVID-19.
Databáze: OpenAIRE
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