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Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China.
JAMA Netw Open. 2020 06 01; 3(6):e2011122.JN

Abstract

Importance

Severe acute respiratory syndrome coronavirus 2 has caused a global outbreak of coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 binds angiotensin-converting enzyme 2 of the rennin-angiotensin system, resulting in hypokalemia.

Objective

To investigate the prevalence, causes, and clinical implications of hypokalemia, including its possible association with treatment outcomes, among patients with COVID-19.

Design, Setting, and Participants

This cohort study was conducted at Wenzhou Central Hospital and Sixth People's Hospital of Wenzhou, Wenzhou, China, from January 11, 2020, to February 15, 2020. Participants included patients who received a diagnosis of COVID-19 according to the criteria issued by the Chinese Health Bureau and were admitted to the hospital. The patients were classified as having severe hypokalemia (plasma potassium <3 mmol/L), hypokalemia (plasma potassium 3-3.5 mmol/L), and normokalemia (plasma potassium >3.5 mmol/L). The clinical features, therapy, and outcomes were compared between the 3 groups. Data analysis was conducted in March 2020.

Interventions

The patients were given general support and antiviral therapy. Their epidemiological and clinical features were collected.

Main Outcomes and Measures

The prevalence of hypokalemia and response to treatment with potassium supplements were measured by analyzing plasma and urine potassium levels.

Results

One hundred seventy-five patients (87 female patients [50%]; mean [SD] age, 45 [14] years) were classified as having severe hypokalemia (31 patients [18%]), hypokalemia (64 patients [37%]), and normokalemia (80 patients [46%]). Patients with severe hypokalemia had statistically significantly higher body temperature (mean [SD], 37.6 °C [0.9 °C]) than the patients with hypokalemia (mean [SD], 37.2 °C [0.7 °C]; difference, 0.4 °C; 95% CI, 0.2-0.6 °C; P = .02) and the patients with normokalemia (mean [SD], 37.1 °C [0.8 °C]; difference, 0.5 °C; 95% CI, 0.3-0.7 °C; P = .005). Patients with higher levels of hypokalemia also had higher creatine kinase levels (severe hypokalemia, mean [SD], 200 [257] U/L [median, 113 U/L; interquartile range {IQR}, 61-242 U/L]; hypokalemia, mean [SD], 97 [85] U/L; and normokalemia, mean [SD], 82 [57] U/L), higher creatine kinase-MB fraction (severe hypokalemia, mean [SD], 32 [39] U/L [median, 14 U/L; IQR, 11-36 U/L]; hypokalemia, mean [SD], 18 [15] U/L; and normokalemia, mean [SD], 15 [8] U/L), higher lactate dehydrogenase levels (mean [SD], severe hypokalemia, 256 [88] U/L; hypokalemia, 212 [59] U/L; and normokalemia, 199 [61] U/L), and higher C-reactive protein levels (severe hypokalemia, mean [SD], 29 [23] mg/L; hypokalemia, mean [SD], 18 [20] mg/L [median, 12, mg/L; IQR, 4-25 mg/L]; and normokalemia, mean [SD], 15 [18] mg/L [median, 6 U/L; IQR, 3-17 U/L]). Of 40 severely and critically ill patients, 34 (85%) had hypokalemia. Patients with severe hypokalemia were given potassium at a dose of 40 mEq per day, for a total mean (SD) of 453 (53) mEq potassium chloride, during the hospital stay. The patients responded well to potassium supplements as they recovered.

Conclusions and Relevance

The correction of hypokalemia is challenging because of continuous renal potassium loss resulting from the degradation of angiotensin-converting enzyme 2. The high prevalence of hypokalemia among patients with COVID-19 suggests the presence of disordered rennin-angiotensin system activity, which increases as a result of reduced counteractivity of angiotensin-converting enzyme 2, which is bound by severe acute respiratory syndrome coronavirus 2.

Authors+Show Affiliations

Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Virus Research Institute, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.Department of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, China.Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. Department of Infectious Diseases, Sixth People's Hospital of Wenzhou, Wenzhou, Zhejiang Province, China.Department of Microbiology, Wenzhou Municipal Centre for Disease Control and Prevention, Wenzhou, Zhejiang Province, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32525548

Citation

Chen, Dong, et al. "Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China." JAMA Network Open, vol. 3, no. 6, 2020, pp. e2011122.
Chen D, Li X, Song Q, et al. Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Netw Open. 2020;3(6):e2011122.
Chen, D., Li, X., Song, Q., Hu, C., Su, F., Dai, J., Ye, Y., Huang, J., & Zhang, X. (2020). Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Network Open, 3(6), e2011122. https://doi.org/10.1001/jamanetworkopen.2020.11122
Chen D, et al. Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Netw Open. 2020 06 1;3(6):e2011122. PubMed PMID: 32525548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. AU - Chen,Dong, AU - Li,Xiaokun, AU - Song,Qifa, AU - Hu,Chenchan, AU - Su,Feifei, AU - Dai,Jianyi, AU - Ye,Yinghai, AU - Huang,Jianping, AU - Zhang,Xiaoming, Y1 - 2020/06/01/ PY - 2020/6/12/entrez PY - 2020/6/12/pubmed PY - 2020/7/1/medline SP - e2011122 EP - e2011122 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 6 N2 - Importance: Severe acute respiratory syndrome coronavirus 2 has caused a global outbreak of coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 binds angiotensin-converting enzyme 2 of the rennin-angiotensin system, resulting in hypokalemia. Objective: To investigate the prevalence, causes, and clinical implications of hypokalemia, including its possible association with treatment outcomes, among patients with COVID-19. Design, Setting, and Participants: This cohort study was conducted at Wenzhou Central Hospital and Sixth People's Hospital of Wenzhou, Wenzhou, China, from January 11, 2020, to February 15, 2020. Participants included patients who received a diagnosis of COVID-19 according to the criteria issued by the Chinese Health Bureau and were admitted to the hospital. The patients were classified as having severe hypokalemia (plasma potassium <3 mmol/L), hypokalemia (plasma potassium 3-3.5 mmol/L), and normokalemia (plasma potassium >3.5 mmol/L). The clinical features, therapy, and outcomes were compared between the 3 groups. Data analysis was conducted in March 2020. Interventions: The patients were given general support and antiviral therapy. Their epidemiological and clinical features were collected. Main Outcomes and Measures: The prevalence of hypokalemia and response to treatment with potassium supplements were measured by analyzing plasma and urine potassium levels. Results: One hundred seventy-five patients (87 female patients [50%]; mean [SD] age, 45 [14] years) were classified as having severe hypokalemia (31 patients [18%]), hypokalemia (64 patients [37%]), and normokalemia (80 patients [46%]). Patients with severe hypokalemia had statistically significantly higher body temperature (mean [SD], 37.6 °C [0.9 °C]) than the patients with hypokalemia (mean [SD], 37.2 °C [0.7 °C]; difference, 0.4 °C; 95% CI, 0.2-0.6 °C; P = .02) and the patients with normokalemia (mean [SD], 37.1 °C [0.8 °C]; difference, 0.5 °C; 95% CI, 0.3-0.7 °C; P = .005). Patients with higher levels of hypokalemia also had higher creatine kinase levels (severe hypokalemia, mean [SD], 200 [257] U/L [median, 113 U/L; interquartile range {IQR}, 61-242 U/L]; hypokalemia, mean [SD], 97 [85] U/L; and normokalemia, mean [SD], 82 [57] U/L), higher creatine kinase-MB fraction (severe hypokalemia, mean [SD], 32 [39] U/L [median, 14 U/L; IQR, 11-36 U/L]; hypokalemia, mean [SD], 18 [15] U/L; and normokalemia, mean [SD], 15 [8] U/L), higher lactate dehydrogenase levels (mean [SD], severe hypokalemia, 256 [88] U/L; hypokalemia, 212 [59] U/L; and normokalemia, 199 [61] U/L), and higher C-reactive protein levels (severe hypokalemia, mean [SD], 29 [23] mg/L; hypokalemia, mean [SD], 18 [20] mg/L [median, 12, mg/L; IQR, 4-25 mg/L]; and normokalemia, mean [SD], 15 [18] mg/L [median, 6 U/L; IQR, 3-17 U/L]). Of 40 severely and critically ill patients, 34 (85%) had hypokalemia. Patients with severe hypokalemia were given potassium at a dose of 40 mEq per day, for a total mean (SD) of 453 (53) mEq potassium chloride, during the hospital stay. The patients responded well to potassium supplements as they recovered. Conclusions and Relevance: The correction of hypokalemia is challenging because of continuous renal potassium loss resulting from the degradation of angiotensin-converting enzyme 2. The high prevalence of hypokalemia among patients with COVID-19 suggests the presence of disordered rennin-angiotensin system activity, which increases as a result of reduced counteractivity of angiotensin-converting enzyme 2, which is bound by severe acute respiratory syndrome coronavirus 2. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32525548/Assessment_of_Hypokalemia_and_Clinical_Characteristics_in_Patients_With_Coronavirus_Disease_2019_in_Wenzhou_China_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.11122 DB - PRIME DP - Unbound Medicine ER -