Hypokalemia as a sensitive biomarker of disease severity and the requirement for invasive mechanical ventilation requirement in COVID-19 pneumonia: A case series of 306 Mediterranean patients

•There is a high prevalence of hypokalemia among patients with COVID-19 pneumonia.•This suggests the presence of a disorder in renin–angiotensin system activity.•Hypokalemia is associated with the requirement for invasive mechanical ventilation.•Hypokalemia appears to be a sensitive biomarker for th...

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Published in:	International journal of infectious diseases Vol. 100; pp. 449 - 454
Main Authors:	Moreno-Pérez, Oscar, Leon-Ramirez, Jose-Manuel, Fuertes-Kenneally, Laura, Perdiguero, Miguel, Andres, Mariano, Garcia-Navarro, Mar, Ruiz-Torregrosa, Paloma, Boix, Vicente, Gil, Joan, Merino, Esperanza, Asensio, Santos, Fernandez, Cleofé, Candela, Alfredo, del Mar García, Mª, Sánchez, Rosario, Reus, Sergio, Ruiz, Paloma, García-Sevila, Raquel, Martínez, María-Ángeles, García-Mullor, María-Mar, Blanes, Mar, Guijarro, Jaime, Pascual, José Carlos, Gonzalez, Iris, Sanso, Pedro, Ramos, José Manuel, Javaloy, Jaime, Llopis, Clara, Coronado, Olga, García, Esther, Rodríguez, Gonzalo, Melgar, Paola, Franco, Mariano, Lluís, Félix, Zaragoza, Carmen, Alcaraz, Cándido, Carrión, Ana, Villodre, Celia, de la Cuesta, Emilio Ruiz, Alenda, Cristina, Peiró, Francisca, Planelles, María, Greco, Laura, Silvia, Sandra, Francia, Antonio, Verdú, Iván, Sales, Juan, Palacios, Ana, Ballester, Hortensia, García-Valentín, Antonio, Márquez, Marta, Canelo, Eva, Juan, Andrea, Vives, Elena
Format:	Journal Article
Language:	English
Published:	Canada Elsevier Ltd 01-11-2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases Elsevier
Subjects:	Adult Aged Aged, 80 and over Betacoronavirus Biomarkers Cohort study Coronavirus Infections - blood Coronavirus Infections - complications Coronavirus Infections - therapy COVID-19 COVID19 pneumonia Female Humans Hypokalemia Hypokalemia - epidemiology Male Mechanical ventilation Middle Aged Mortality Pandemics Pneumonia, Viral - blood Pneumonia, Viral - complications Pneumonia, Viral - therapy Respiration, Artificial Retrospective Studies SARS-CoV-2 Severity of Illness Index Hypokalemia COVID19 pneumonia Mechanical ventilation Mortality Cohort study
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Summary:	•There is a high prevalence of hypokalemia among patients with COVID-19 pneumonia.•This suggests the presence of a disorder in renin–angiotensin system activity.•Hypokalemia is associated with the requirement for invasive mechanical ventilation.•Hypokalemia appears to be a sensitive biomarker for the progression of severity in COVID-19.•Serum levels of potassium should be monitored closely in these patients. Serum levels of potassium (K+) appear to be significantly lower in severe cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the clinical significance of this is unknown. The objective was to investigate whether hypokalemia acts as a biomarker of severity in coronavirus disease 2019 (COVID-19) pneumonia and is associated with major clinical outcomes. A retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 to May 2, 2020) was performed. Patients were categorized according to nadir levels of K+ in the first 72 h of admission: hypokalemia (K+ ≤3.5 mmol/l) and normokalemia (K+ >3.5 mmol/l). The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV); these were analyzed by multiple logistic regression (odds ratio (OR), 95% confidence interval (CI)). Three hundred and six patients were enrolled. Ninety-four patients (30.7%) had hypokalemia and these patients showed significantly higher comorbidity (Charlson comorbidity index ≥3, 30.0% vs 16.3%; p = 0.02) and CURB65 scores (median (interquartile range): 1.5 (0.0–3.0) vs 1.0 (0.0–2.0); p = 0.04), as well as higher levels of some inflammatory parameters at baseline. After adjustment for confounders, hypokalemia was independently associated with requiring IMV during the admission (OR 8.98, 95% CI 2.54–31.74). Mortality was 15.0% (n = 46) and was not influenced by low K+. Hypokalemia was associated with longer hospital and ICU stays. Hypokalemia is prevalent in patients with COVID-19 pneumonia. Hypokalemia is an independent predictor of IMV requirement and seems to be a sensitive biomarker of severe progression of COVID-19.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1201-9712 1878-3511
DOI:	10.1016/j.ijid.2020.09.033