Frequency, Management, and Outcomes of Outpatient Hyperkalemia: A Population-Based Cohort Study
Notice bibliographique
Résumé
Background: Hyperkalemia is a potentially life-threatening condition, with guidelines recommending urgent treatment when the serum potassium level is greater than 6.0 mmol/L. However, these recommendations are inconsistent, leading to diverse approaches to patient care. Objectives: The primary objectives were to use population-based datasets to determine how often outpatient hyperkalemia (K > 6.2 mmol/L) occurs and how frequently patients present to the emergency department (ED) within 24 hours of the hyperkalemia report. Secondary objectives were to compare the characteristics of patients who had an ED encounter to those who did not, assess clinical outcomes within 7 days of the hyperkalemia report, and describe the initial potassium result within 24 hours of an ED encounter. Design: Retrospective cohort study using linked population-based datasets at ICES. Setting: Ontario, Canada from January 1, 2007, to December 24, 2021. Patients: Adult patients (≥18 years) not on dialysis with an outpatient hyperkalemia result >6.2 mmol/L who were identified through flagged and urgently communicated results from outpatient laboratories. Measurements: Emergency department encounters within 24 hours following an outpatient serum potassium report >6.2 mmol/L. Outcomes included all-cause mortality, cardiovascular mortality, arrhythmias, cardiac arrest in the ED, hospitalizations, and new dialysis starts within 7 days of the hyperkalemia report. Methods: Administrative healthcare data were linked with laboratory results to compare baseline characteristics, medication use, healthcare utilization, and clinical outcomes for all patients. Standardized differences were used for comparisons. Results: There were over 65 million serum potassium measurements and 57 607 individuals with an outpatient hyperkalemia value >6.2 mmol/L. Of these, 7469 (13.0%) individuals had an ED encounter within 24 hours. Individuals with an ED encounter had more comorbidities, higher medication use, and more prior healthcare utilization. Within 7 days of the hyperkalemia report, 675 of the 57 607 individuals (1.2%) had died. Where data were available, the first potassium value within 24 hours of an ED encounter was 1.5 mmol/L (± SD 1.3) lower, on average, than the initial outpatient potassium value. Limitations: All-cause mortality may not be attributable to the hyperkalemia result. Sudden cardiac death, which is more specific to hyperkalemia, is not completely captured in our data sources. Data for medications are limited to patients 65 years of age and older. Conclusions: Outpatient hyperkalemia is common. Despite guidelines recommending urgent treatment for patients with serum potassium levels >6.2 mmol/L, most are not referred to the ED.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».