The association between arrival potassium and 30-day survival following resuscitation from out-of-hospital cardiac arrest: a retrospective cohort study
Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patien...
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| Vydáno v: | Scandinavian journal of trauma, resuscitation and emergency medicine Ročník 33; číslo 1; s. 144 - 10 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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BioMed Central
26.08.2025
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1757-7241, 1757-7241 |
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| Abstract | Background
It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.
Methods
We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.
Results
Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.
Conclusions
In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. |
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| AbstractList | Background
It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.
Methods
We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.
Results
Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.
Conclusions
In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA. Methods We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm. Results Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia. Conclusions In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. Keywords: Out-of-hospital cardiac arrest survivors, Potassium, Survival BackgroundIt is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.MethodsWe identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.ResultsOver the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.ConclusionsIn OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. Abstract Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA. Methods We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm. Results Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia. Conclusions In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA. We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm. Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia. In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.BACKGROUNDIt is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.METHODSWe identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.RESULTSOver the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival.CONCLUSIONSIn OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA. We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm. Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia. In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival. |
| ArticleNumber | 144 |
| Audience | Academic |
| Author | Pareek, Manan Wissenberg, Mads Folke, Fredrik Hassager, Christian Byrne, Christina Torp-Pedersen, Christian Ringgren, Kristian Bundgaard Riddersholm, Signe Gislason, Gunnar Krogager, Maria Lukacs Kragholm, Kristian Mohr, Grimur Høgnason Kjærgaard, Jesper Fordyce, Christopher B. Barcella, Carlo A. Wolder, Martin Lip, Gregory Y. H. Køber, Lars |
| Author_xml | – sequence: 1 givenname: Christina surname: Byrne fullname: Byrne, Christina email: christina.byrne@regionh.dk organization: Department of Cardiology, Rigshospitalet, University of Copenhagen – sequence: 2 givenname: Maria Lukacs surname: Krogager fullname: Krogager, Maria Lukacs organization: Department of Cardiology, Aalborg University Hospital – sequence: 3 givenname: Kristian surname: Kragholm fullname: Kragholm, Kristian organization: Department of Cardiology, Aalborg University Hospital – sequence: 4 givenname: Manan surname: Pareek fullname: Pareek, Manan organization: Department of Cardiology, Rigshospitalet, University of Copenhagen, Department of Cardiology, Copenhagen University Hospital – sequence: 5 givenname: Grimur Høgnason surname: Mohr fullname: Mohr, Grimur Høgnason organization: Department of Cardiology, Copenhagen University Hospital, Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen – sequence: 6 givenname: Kristian Bundgaard surname: Ringgren fullname: Ringgren, Kristian Bundgaard organization: Department of Cardiology, Aalborg University Hospital – sequence: 7 givenname: Mads surname: Wissenberg fullname: Wissenberg, Mads organization: Department of Cardiology, Rigshospitalet, University of Copenhagen, Department of Cardiology, Copenhagen University Hospital – sequence: 8 givenname: Signe surname: Riddersholm fullname: Riddersholm, Signe organization: Department of Cardiology, Aalborg University Hospital – sequence: 9 givenname: Martin surname: Wolder fullname: Wolder, Martin organization: Department of Cardiology, Aalborg University Hospital – sequence: 10 givenname: Fredrik surname: Folke fullname: Folke, Fredrik organization: Department of Cardiology, Copenhagen University Hospital – sequence: 11 givenname: Gunnar surname: Gislason fullname: Gislason, Gunnar organization: Department of Cardiology, Copenhagen University Hospital – sequence: 12 givenname: Lars surname: Køber fullname: Køber, Lars organization: Department of Cardiology, Rigshospitalet, University of Copenhagen – sequence: 13 givenname: Christian surname: Hassager fullname: Hassager, Christian organization: Department of Cardiology, Rigshospitalet, University of Copenhagen – sequence: 14 givenname: Jesper surname: Kjærgaard fullname: Kjærgaard, Jesper organization: Department of Cardiology, Rigshospitalet, University of Copenhagen – sequence: 15 givenname: Christopher B. surname: Fordyce fullname: Fordyce, Christopher B. organization: Department of Medicine and the Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia – sequence: 16 givenname: Christian surname: Torp-Pedersen fullname: Torp-Pedersen, Christian organization: Department of Cardiology, North Zealand Hospital – sequence: 17 givenname: Gregory Y. H. surname: Lip fullname: Lip, Gregory Y. H. organization: Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liver-pool, United Kingdom; and Department of Clinical Medicine, Aalborg University – sequence: 18 givenname: Carlo A. surname: Barcella fullname: Barcella, Carlo A. organization: Department of Cardiology, Rigshospitalet, University of Copenhagen, Department of Cardiology, Copenhagen University Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40859315$$D View this record in MEDLINE/PubMed |
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| Keywords | Out-of-hospital cardiac arrest survivors Potassium Survival |
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It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA)... It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors.... Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA)... BackgroundIt is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA)... Abstract Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac... |
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| SubjectTerms | Aged Cardiac arrest Cardiac resuscitation Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - methods Cardiopulmonary Resuscitation - mortality Care and treatment CPR Denmark - epidemiology Disease Drug overdose Emergency medical care Emergency Medicine Female Health aspects Hospital care Hospitals Humans Male Measurement Medical prognosis Medicine Medicine & Public Health Middle Aged Missing data Mortality Out-of-Hospital Cardiac Arrest - blood Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - therapy Out-of-hospital cardiac arrest survivors Patient outcomes Patients Potassium Potassium - blood Potassium in the body Registries Retrospective Studies Survival Survival Rate - trends Traumatic Surgery |
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| Title | The association between arrival potassium and 30-day survival following resuscitation from out-of-hospital cardiac arrest: a retrospective cohort study |
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