Severe hyperkalemia requiring hospitalization predictors of mortality 英文参考文献.docVIP

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Severe hyperkalemia requiring hospitalization predictors of mortality 英文参考文献.doc

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Severe hyperkalemia requiring hospitalization predictors of mortality 英文参考文献

Anetal.CriticalCare2012,16:R225 /content/16/6/R225 RESEARCH OpenAccess Severehyperkalemiarequiringhospitalization: predictorsofmortality JungNamAn1,JungPyoLee1,2,HeeJungJeon1,DoHyoungKim1,YunKyuOh1,2,YonSuKim1and ChunSooLim1,2* Abstract Introduction:Severehyperkalemia,withpotassium(K+)levels≥6.5mEq/L,isapotentiallylife-threatening electrolyteimbalance.Forpromptandeffectivetreatment,itisimportanttoknowitsriskfactors,clinical manifestations,andpredictorsofmortality. Methods:Anobservationalcohortstudywasperformedat2medicalcenters.Atotalof923consecutiveKorean patientswereanalyzed.Allwere19yearsofageorolderandwerehospitalizedwithseverehyperkalemiabetween August2007andJuly2010;thediagnosisofseverehyperkalemiawasmadeeitheratthetimeofadmissiontothe hospitalorduringtheperiodofhospitalization.Demographicandbaselineclinicalcharacteristicsatthetimeof hyperkalemiadiagnosiswereassessed,andclinicaloutcomessuchasin-hospitalmortalitywerereviewed,usingthe institutions’electronicmedicalrecordsystems. Results:Chronickidneydisease(CKD)wasthemostcommonunderlyingmedicalcondition,andthemost commonprecipitatingfactorofhyperkalemiawasmetabolicacidosis.Emergentadmissionwasindicatedin68.6% ofpatients,36.7%hadelectrocardiogramfindingstypicalofhyperkalemia,24.5%hadmulti-organfailure(MOF)at thetimeofhyperkalemiadiagnosis,and20.3%werediagnosedwithseverehyperkalemiaatthetimeofcardiac arrest.Thein-hospitalmortalityratewas30.7%;theratewasstronglycorrelatedwiththedifferencebetweenserum K+levelsatadmissionandattheirhighestpoint,andwithseveremedicalconditionssuchasmalignancy,infection, andbleeding.Furthermore,ahigherin-hospitalmortalityratewassignificantlyassociatedwiththepresenceof cardiacarrestand/orMOFatthetimeofdiagnosis,emergentadmission,andintensivecareunittreatmentduring hospitalization.Moreimportantly,acutekidneyinjury(AKI)inpatientswithnormalbaselinerenalfunctionwasa strongpredictorofmortality,comparedwithAKIsuperimposedonCKD. Conclusions:Severehyperkalemiaoccursinvariousmedicalconditions;thepr