Key result
Greater in-hospital potassium changes linked to ~18% higher 30-day mortality in ADHF.
Why the study?
Evidence on potassium disturbances in critically ill ADHF patients requiring intensive care is limited, and the prognostic significance of dynamic in-hospital potassium changes in this population remains unclear.
Cohort (n=4,848)
No
Greater in-hospital potassium fluctuations are independently associated with a U-shaped increase in 30-day all-cause mortality among critically ill patients admitted to the coronary care unit with acute decompensated heart failure.
Greater potassium fluctuations may aid short-term risk stratification in ADHF; extends observational associations but leaves causal effects and management changes open.
Background Potassium disturbances have been associated with adverse outcomes in heart failure; however, evidence in critically ill patients with acute decompensated heart failure (ADHF) requiring intensive care is limited. The prognostic significance of dynamic in-hospital potassium changes in this population remains unclear. Methods In this retrospective, single-center cohort study, we consecutively enrolled patients with ADHF admitted to the coronary care unit between January 2011 and December 2020. Baseline clinical characteristics, including serum potassium levels on admission and changes from admission to discharge, were collected. The primary outcome was 30-day all-cause mortality. Results A total of 4,848 patients were included (mean age 75.5 ± 13.8 years; 66.9% male). The mean admission potassium level was 4.3 ± 0.7 mmol/L. Overall, 1,316 patients (27.1%) died within 30 days. Higher admission serum potassium levels were associated with increased 30-day mortality. Restricted cubic spline analysis demonstrated a U-shaped relationship between in-hospital potassium changes and 30-day mortality. Patients were stratified into tertiles according to the absolute magnitude of potassium changes. Greater absolute potassium changes were associated with higher 30-day mortality (tertile 1 vs. tertile 2 vs. tertile 3 = 386 [23.9%] vs. 415 [25.7%] vs. 515 [31.9%]; P < 0.001). In the multivariable Cox proportional hazards analysis, the absolute magnitude of in-hospital potassium change was independently associated with 30-day mortality (hazard ratio 1.182, 95% confidence interval 1.077–1.296; P < 0.001), after adjustment for age, sex, body mass index, baseline estimated glomerular filtration rate, and other relevant clinical covariates. Conclusions Greater in-hospital potassium fluctuations were independently associated with increased short-term mortality, suggesting that potassium dynamics may have important prognostic implications in critically ill patients with ADHF.Figure 1TsKFigure 2TeTs
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Hsu et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=4,848). In-hospital serum potassium changes (highest absolute magnitude tertile) vs. Lowest absolute magnitude tertile of potassium change was evaluated on 30-day all-cause mortality (HR 1.182, 95% CI 1.077-1.296, p=<0.001). Greater absolute in-hospital potassium changes were independently associated with increased 30-day all-cause mortality in ADHF patients (HR 1.182; 95% CI 1.077-1.296; P<0.001).
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