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. (November 2020)

• Record Type: Journal Article
• Authors: Moreno-P, Oscar; Leon-Ramirez, Jose-Manuel; Fuertes-Kenneally, Laura; Perdiguero, Miguel; Andres, Mariano; Garcia-Navarro, Mar; Ruiz-Torregrosa, Paloma; Boix, Vicente; Gil, Joan; Merino, Esperanza; Asensio, Santos; Fernandez, Cleofé; Candela, Alfredo; del Mar García, Mª; Sánchez, Rosario; Reus, Sergio; Ruiz, Paloma; García-Sevila, Raquel; Martínez, María-Ángeles; García-Mullor, María-Mar; Blanes, Mar; Guijarro, Jaime; Pascual, José Carlos; Gonzalez, Iris; Sanso, Pedro; Ramos, José Manuel; Javaloy, Jaime; Llopis, Clara; Coronado, Olga; García, Esther; Rodríguez, Gonzalo; Melgar, Paola; Franco, Mariano; Lluís, Félix; Zaragoza, Carmen; Alcaraz, Cándido; Carrión, Ana; Villodre, Celia; de la Cuesta, Emilio Ruiz; Alenda, Cristina; Peiró, Francisca; Planelles, María; Greco, Laura; Silvia, Sandra; Francia, Antonio; Verdú, Iván; Sales, Juan; Palacios, Ana; Ballester, Hortensia; García-Valentín, Antonio; Márquez, Marta; Canelo, Eva; Juan, Andrea; Vives, Elena; Revert, Andrea; Fuente, Gonzalo; Nofuentes, Ester; Mangas, Carolina; Vera, Eva; Ferradas, Alicia; López, Helena; Herrera, Cristian; López, Beatriz; Morillas, Marina; Rodríguez, Vanesa; Khartabil, Mercedes; Giménez, Mario; Tovar, Ernesto; Martínez, Estela; Medina, Lucia; Baile, Sandra; Salazar, Carlos; Guerra, Norma; Moliner, Sarai; López-González, Mari-Carmen; Figueres, Blanca;
• Is Part Of: International journal of infectious diseases. Volume 100(2020)
• Page Start: 449
• Page End: 454
• Publication Date: 2020-11
• Subjects: COVID19 pneumonia -- Hypokalemia -- Mortality -- Mechanical ventilation -- Cohort study; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.09.033
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: There is a high prevalence of hypokalemia among patients with COVID-19 pneumonia. This suggests the presence of a disorder in renin–angiotensin system activity. Hypokalemia is associated with the requirement for invasive mechanical ventilation. Hypokalemia appears to be a sensitive biomarker for the progression of severity in COVID-19. Serum levels of potassium should be monitored closely in these patients. Abstract: Objectives: Serum levels of potassium (K + ) appear to be significantly lower in severe cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the clinical significance of this is unknown. The objective was to investigate whether hypokalemia acts as a biomarker of severity in coronavirus disease 2019 (COVID-19) pneumonia and is associated with major clinical outcomes. Methods: A retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 to May 2, 2020) was performed. Patients were categorized according to nadir levels of K + in the first 72 h of admission: hypokalemia (K + ≤3.5 mmol/l) and normokalemia (K + >3.5 mmol/l). The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV); these were analyzed by multiple logistic regression (odds ratio (OR), 95% confidence interval (CI)). Results: Three hundred and six patients were enrolled. Ninety-four patients (30.7%) had hypokalemia and these patients showed significantly higher comorbidity (Charlson comorbidity index ≥3, 30.0% vs 16.3%; p = 0.02) and CURB65 scores (median (interquartile range): 1.5 (0.0–3.0) vs 1.0 (0.0–2.0); p = 0.04), as well as higher levels of some inflammatory parameters at baseline. 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 stays. 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.