title: Prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis.
abstract: BACKGROUND
  The prevalence and clinical significance of hyponatremia in cirrhotics have been well studied; however, there are limited data on hyperkalemia in cirrhotics.
  
  
  OBJECTIVE
  We evaluated the prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis and developed a prognostic model incorporating potassium for prediction of liver-related death in these patients.
  
  
  METHODS
  The training derivative cohort of patients was used for development of prognostic scores (Group A, n = 1160), which were validated in a large prospective cohort of cirrhotic patients. (Group B, n = 2681) of cirrhosis.
  
  
  RESULTS
  Hyperkalemia was seen in 189 (14.1%) and 336 (12%) in Group A and Group B, respectively. Potassium showed a significant association that was direct with creatinine (P < 0.001) and urea (P < 0.001) and inverse with sodium (P < 0.001). Mortality was also significantly higher in patients with hyperkalemia (P = 0.0015, Hazard Ratio (HR) 1.3, 95% confidence interval 1.11-1.57). Combination of all these parameters into a single value predictor, that is, renal dysfunction index predicted mortality better than the individual components. Combining renal dysfunction index with other known prognostic markers (i.e. serum bilirubin, INR, albumin, hepatic encephalopathy, and ascites) in the "K" model predicted both short-term and long-term mortality with an excellent accuracy (Concordance-index 0.78 and 0.80 in training and validation cohorts, respectively). This was also superior to Model for End-stage Liver Disease, Model for End-stage liver disease sodium (MELDNa), and Child-Turcott-Pugh scores.
  
  
  CONCLUSIONS
  Cirrhotics frequently have impaired potassium homeostasis, which has a prognostic significance. Serum potassium correlates directly with serum creatinine and urea and inversely with serum sodium. The model incorporating serum potassium developed from this study ("K"model) can predict death in advanced cirrhotics with an excellent accuracy.
authors.affiliation: Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Department of Hematology, Command Hospital (Eastern Command), Kolkata, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Sharma
authors.affiliation: Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.|Department of Gastroenterology, Jawaharlal Nehru Hospital, Srinagar, Kashmir, India.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Wani
authors.affiliation: Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Mulu
authors.initials: M
authors.lastname: Ozukum
authors.affiliation: Departments of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D007194:India / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D011188:Potassium
keywords: chronic liver disease; hyperkalemia; hyponatremia; prognostic model; renal dysfunction