Key result
Admission serum potassium <2.5 mmol/L is linked to ~4.5 days longer hospital stay versus normokalaemia.
Why the study?
While the adverse effect of dyskalaemia on mortality is well described, few data exist regarding its effect on hospital length of stay.
Does dyskalaemia at admission increase length of hospital stay in patients requiring emergency hospital admission?
Meta-Analysis
Does dyskalaemia at admission increase length of hospital stay in patients requiring emergency hospital admission?
Effect estimate: Difference of medians 4.45 (for <2.5 mmol/L) (95% CI 2.71-6.91)
Hospital length of stay follows a U-shaped distribution with admission potassium levels, being twofold greater at the extremes of the potassium range.
Severe hypokalaemia may prolong stay in emergency admissions; leaves open whether correction shortens hospitalization.
Objective Hypokalaemia and hyperkalaemia (‘dyskalaemia’) are commonly seen in patients requiring emergency hospital admission. The adverse effect of dyskalaemia on mortality is well described but there are few data for the effect on hospital length of stay. We sought to determine the association of serum potassium concentration with in-hospital length of stay. Design Systematic review and meta-analysis. Data sources A structured search of MEDLINE, PubMed and SCOPUS databases to 19 March 2021. Eligibility criteria Observational cohort studies defining exposure of interest as serum potassium levels (at admission or within the first 72 hours) and with outcome of interest as length of hospital stay. Studies had to provide estimates of length of stay as a comparison between normokalaemia and defined ranges of hyperkalaemia or hypokalaemia. Data extraction and synthesis We identified 39 articles published to March 2021 that met the inclusion and exclusion criteria. Study selection, data extraction and quality assessment were carried out by two reviewers working independently and in duplicate, to assessed eligibility and risk of bias, and extract data from eligible studies. Random effects models were used to pool estimates across the included studies. Meta-analyses were performed using Cochrane-RevMan. Results Five studies were included in the meta-analysis. Compared with the reference group (3.5–5.0 mmol/L), the pooled raw differences of medians were 4.45 (95% CI 2.71 to 6.91), 1.99 (95% CI 0.03 to 3.94), 0.98 (95% CI 0.91 to 1.05), 1.51 (95% CI 1.03 to 2.0), 1 (95% CI 0.75 to 1.25) and 2.76 (95% CI 1.24 to 4.29) for patients with potassium levels of <2.5, 2.5 to <3.0, 3.0 to <3.5, <5 to 5.5, <5.5 to 6 and >6.0 mmol/L, respectively. Conclusion Hospital length of stay follows a U-shaped distribution, with duration of admission being twofold greater at the extremes of the potassium range.
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Ellis et al. (2023) conducted a meta-analysis in Emergency hospital admission. Dyskalaemia (abnormal serum potassium levels) vs. Normokalaemia (3.5-5.0 mmol/L) was evaluated on Length of hospital stay (Difference of medians 4.45 (for <2.5 mmol/L), 95% CI 2.71-6.91). Admission serum potassium <2.5 mmol/L increased hospital length of stay compared to normokalaemia (difference of medians 4.45; 95% CI 2.71-6.91), with a U-shaped distribution across ranges.