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.

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.

• Authors: 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, COVID19-ALC Research Group
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 100 Pg. 449-454 (Nov 2020) ISSN: 1878-3511 [Electronic] Canada
• PMID: 32950739 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Biomarkers

Topics

• Adult
• Aged
• Aged, 80 and over
• Betacoronavirus
• Biomarkers
• COVID-19
• Coronavirus Infections (blood, complications, therapy)
• Female
• Humans
• Hypokalemia (epidemiology)
• Male
• Middle Aged
• Pandemics
• Pneumonia, Viral (blood, complications, therapy)
• Respiration, Artificial
• Retrospective Studies
• SARS-CoV-2
• Severity of Illness Index