title: Serum potassium decline during hospitalization for acute decompensated heart failure is a predictor of 6-month mortality, independent of N-terminal pro-B-type natriuretic peptide levels: An individual patient data analysis.
abstract: BACKGROUND
  Limited data exist for the role of serum potassium changes during hospitalization for acute decompensated heart failure (ADHF). The present study investigated the long-term prognostic value of potassium changes during hospitalization in patients admitted for ADHF.
  
  
  METHODS
  Our study is a pooled individual patient data analysis assembled from 3 prospective cohorts comprising 754 patients hospitalized for ADHF. The endpoint was all-cause mortality within 180 days after discharge. Serum potassium levels and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured at admission and at discharge.
  
  
  RESULTS
  A percentage decrease >15% in serum potassium levels occurred in 96 (13%) patients, and an absolute decrease of >0.7 mmol/L in serum potassium levels occurred in 85 (12%) patients; and both were predictors of poor outcome independent of admission or discharge serum potassium. After the addition of other strong predictors of mortality-a 30% change in NT-proBNP during hospitalization, discharge levels of NT-proBNP, renal markers, and other relevant clinical variables-the multivariate hazard ratio of serum potassium percentage reduction of >15% remained an independent predictor of 180-day mortality (hazard ratio 2.06, 95% CI 1.14-3.73).
  
  
  CONCLUSIONS
  A percentage serum potassium decline of >15% is an independent predictor of 180-day all-cause mortality on top of baseline potassium levels, NT-proBNP levels, renal variables, and other relevant clinical variables. This suggest that patients hospitalized for ADHF with a decline of >15% in serum potassium levels are at risk and thus monitoring and regulating of serum potassium level during hospitalization are needed in these patients.
authors.affiliation: Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands. Electronic address: k.salah@amc.uva.nl.
authors.forename: Khibar
authors.initials: K
authors.lastname: Salah
authors.affiliation: Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands.
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
authors.affiliation: University Hospital Maastricht, Department of Cardiology, Maastricht, the Netherlands.
authors.forename: Luc W
authors.initials: LW
authors.lastname: Eurlings
authors.affiliation: University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: Stienen
authors.affiliation: University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology, Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Academic Medical Center, University of Amsterdam, Heart failure Research Center & Department of Cardiology, Amsterdam, the Netherlands.
authors.forename: Wouter E
authors.initials: WE
authors.lastname: Kok
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D007008:Hypokalemia / Q000097:blood* / Q000209:etiology / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009426:Netherlands / Q000453:epidemiology; D010446:Peptide Fragments / Q000097:blood*; D011188:Potassium / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D011188:Potassium