Moderate hyperkalemia in hospitalized patients with cirrhotic ascites indicates a poor prognosis

Figures & data

Table I. Laboratory tests and MELD and CTP scores (see text) in patients with cirrhotic ascites; hazard ratio (HR) and confidence interval (CI). B = blood, S = serum, AST = aspartate amino transferase, ALT = alanine amino transferase, ALP = alkaline phosphatases, NS = not significant, * = p < 0.05, ** = p < 0.01, *** = p < 0.001.

	N	Mean	HR	CI	p-value
B-Hemoglobin (g/L)	155	114.7	1.00	0.99–1.01	NS
B-Leukocytes (10^9/L)	153	10.3	1.02	0.99–1.05	NS
B-Platelets (10^9/L)	154	178.6	1.00	1.00–1.00	NS
S-AST (μkat/L)^1	154	2.08	1.14	1.09–1.20	0.0000***
S-ALT (μkat/L)^1	154	0.89	1.51	1.29–1.77	0.0000***
S-ALP (μkat/L)^1	153	8.8	1.03	1.01–1.06	0.0172*
S-Bilirubin (mmol/L)	153	102	1.00	1.00–1.01	0.0004***
INR	153	1.49	0.82	0.45–1.50	0.5278NS
S-Sodium (mmol/L)	155	133.3	0.96	0.93–1.00	0.0700NS
S-K (mmol/L)	155	3.99	2.18	1.57–3.03	0.0000***
S-Creatinine (mmol/L)	154	131.6	1.00	1.00–1.00	0.0274*
S-Urea (mmol/L)	88	11.00	1.05	1.02–1.07	0.0001***
S-Albumin (g/L)	147	24.87	1.01	0.98–1.03	0.6145NS
CTPI score	142	11.2	1.04	0.98–1.09	0.1705NS
CTPII score	142	10.2	1.05	0.99–1.11	0.1061NS
MELD score	150	17.4	1.04	1.01–1.06	0.0039**

¹Upper limits of normal were for AST 0.8, ALT 0.8, and ALP 5.0.

Table II. One-year survival in 155 patients according to abdominal tenderness, serum potassium value (ref. value 3.6–4.6 mmol/L), and MELD score at inclusion in the study.

	OLT and/or death <1 year
	OLT		No OLT
	Dead	Alive	Dead	Alive (%)	All
Abdominal tenderness
No	2	8	46	46^1 (45)	102
Yes	0	1	33	16 (32)	50
All	2	9	79	62^1 (41)	152
Serum potassium
< 3.6	0	4	15	24 (56)	43
3.6–4.1	1	2	24	27 (50)	54
4.2–4.6	1	3	19	12 (34)	35
> 4.6	0	0	22	1 (4)	23
All	2	9	80	64 (41)	155
MELD score
6–9	0	2	10	15 (56)	27
10–19	1	6	34	29 (41)	70
20–29	1	0	27	16 (36)	44
≥ 30	0	1	6	2^2 (22)	9
All	2	9	77	62 (41)	150

¹This figure includes two patients with OLT performed > 1 year after inclusion; ²This figure includes one patient with score 32, and one patient with score 34.

Table III. Use of potassium-saving drugs or potassium chloride in 155 patients according to serum potassium at inclusion in the study.

	Type of potassium-saving drug
S-K	Spironolactone	Amiloride	Potassium chloride	None	No drug declared	All
<3.6	15	0	2	22	4	43
3.6–4.1	23	3	1	20	7	54
4.2–4.6	26	0	0	8	1	35
>4.6	15	1	0	6	1	23
All	79	4	3	56	13	155

Table IV. Area under the ROC curve (95% CI) for death at 1 month, at one year, and at five years after inclusion in the present study for routine laboratory tests reflecting kidney function, some scoring models, and the risk formula, which is described in the Multivariable analysis section and constructed according to the results of the study. The abbreviations CTP_I, CTP_II, and MELD are explained in the Methods section.

	1 month	1 year	5 years
S-K	0.744 (0.641–0.847)	0.710 (0.629–0.790)	0.662 (0.563–0.761)
S-Urea	0.839 (0.727–0.952)	0.717 (0.610–0.824)	0.637 (0.509–0.765)
S-Creatinine	0.729 (0.623–0.834)	0.693 (0.610–0.776)	0.663 (0.564–0.762)
CTPI score	0.656 (0.538–0.773)	0.538 (0.443–0.633)	0.470 (0.359–0.581)
CTPII score	0.672 (0.557–0.788)	0.568 (0.474–0.663)	0.495 (0.383–0.606)
MELD score	0.772 (0.674–0.870)	0.643 (0.555–0.731)	0.560 (0.455–0.666)
Our risk formula	0.761 (0.661–0.861)	0.742 (0.664–0.821)	0.698 (0.602–0.795)

Table V. Variables from the multivariable analyses; hazard ratio (HR) and confidence interval (CI). * = p < 0.05, ** = p < 0.01, *** = p < 0.001.

	Beta value	HR	CI	p-value
S-K	0.7717	2.16	1.56–2.99	0.0000***
Abdominal tenderness	0.5356	1.71	1.16–2.52	0.0071**
Alcohol use	–0.3449	0.71	0.56–0.89	0.0037**
S-AST	0.0961	1.10	1.05–1.16	0.0001***

Besides the variables above, the hazard function includes a constant and four variables, which are functions of updated time since start of follow-up and of age.

Table VI. The hazard function mentioned in the text could be used for the calculation of the 1-, 2-, and 5-year survival; see examples below. Thus it is possible to apply the results to present a risk engine in this area.

					Probability of surviving
Age	Abdominal tenderness	S-K	S-AST	Alcohol use (see text)	1 year	2 years	5 years
73.62	0	3.7	1.3	1	0.496	0.382	0.218
70.70	0	4.1	0.98	1	0.384	0.269	0.125
61.80	0	4.0	4.1	1	0.326	0.209	0.073
56.92	1	4.5	1.56	0	0.084	0.031	0.003
59.27	0	2.9	1.78	2	0.785	0.714	0.566
51.69	0	4.5	1.72	1	0.442	0.320	0.147
44.42	0	3.3	5.1	2	0.799	0.730	0.589
46.28	0	4.4	1.4	0	0.449	0.326	0.152
46.01	0	5.8	1.2	1	0.198	0.104	0.022
41.65	0	2.6	1.5	1	0.891	0.852	0.763