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Prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis.
J Gastroenterol Hepatol. 2015 Nov 24;
Authors: Maiwall R, Kumar S, Sharma MK, Wani Z, Ozukum M, Sarin SK
Abstract
BACKGROUND: The prevalence and clinical significance of hyponatremia in cirrhotics has been well-studied, however there is limited data on hyperkalemia in cirrhotics.
AIM: We evaluated the prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis and developed a prognostic model incorporating potassium for prediction of liver-related death in these patients.
METHODS: The training derivative cohort of patients was used for development of prognostic scores(Gr.A,n = 1160) which were validated in a large prospective cohort of cirrhotic patients. (Gr.B,n = 2681) of cirrhosis.
RESULTS: Hyperkalemia was seen in 189 (14.1%) and 336 (12%) in Gr A and Gr B respectively. Potassium showed a significant association which was direct with creatinine (p < 0.001) and urea (p < 0.001) and inverse with sodium (p < 0.001). Mortality was also significantly higher in patients with hyperkalemia(p = 0.0015, HR 1.3, 95% CI 1.11-1.57). Combination of all these parameters into a single value predictor i.e. renal dysfunction index (RDI) predicted mortality better than the individual components. Combining RDI with other known prognostic markers (i.e. serum bilirubin, INR, albumin, hepatic encephalopathy and ascites) in the 'K' model predicted both short and long term mortality with an excellent accuracy (C-index 0.78 and 0.80 in training and validation cohorts respectively). This was also superior to MELD, MELDNa and CTP scores.
CONCLUSIONS: Cirrhotics frequently have impaired potassium homeostasis which has a prognostic significance. Serum potassium correlates directly with serum creatinine and urea and inversely with serum sodium. The model incorporating serum potassium developed from this study ('K'model) can predict death in advanced cirrhotics with an excellent accuracy.
PMID: 26598065 [PubMed - as supplied by publisher]