ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1582894
This article is part of the Research TopicOutcome of Sepsis and Prediction of Mortality Risk - Volume IIView all articles
Liner association Between Serum Potassium Levels and 28-Day Mortality Among ICU Patients with Diabetes and Sepsis: A Multicenter Study
Provisionally accepted
- 1Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- 2Department of Epidemiology and Biostatistics, Empower U, X&Y solutions Inc., Boston, USA., Boston, United States
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Background: Dysregulation of serum potassium is a common electrolyte disturbance in critically ill patients, and both hypokalemia and hyperkalemia have been linked to adverse outcomes in sepsis. However, the relationship between serum potassium levels and mortality in ICU patients with diabetes and sepsis remains poorly understood.Methods: A retrospective cohort study was conducted using data from the eICU Collaborative Research Database (2014Database ( -2015)). The study included 5,104 adult ICU patients with diabetes and sepsis from 208 hospitals in the U.S. Serum potassium levels measured within 24 hours of ICU admission were categorized into hypokalemia (<3.5 mmol/L), normokalemia (3.5-5.0 mmol/L), and hyperkalemia (>5.0 mmol/L).Multivariable logistic regression models were used to assess the association between serum potassium levels and 28-day ICU mortality.Results: Of the 5,104 patients (mean age, 66.8 years; 49.1% male), 1,046 (20.5%) had hypokalemia, 3,377 (66.2%) had normokalemia, and 681 (13.3%) had hyperkalemia.After adjusting for demographic factors, comorbidities, and treatment measures, each 1 mmol/L increase in serum potassium was associated with a 25% higher risk of 28-day mortality (adjusted OR, 1.25; 95% CI, 1.07-1.47). Compared to hypokalemia, hyperkalemia was associated with significantly higher mortality risk (adjusted OR, 1.86; 95% CI, 1.17-2.96). A linear relationship was observed between serum potassium levels and mortality (P=.006), differing from the previously reported U-shaped relationship in general ICU populations.Conclusions and Relevance: Elevated serum potassium levels were independently associated with increased 28-day mortality in ICU patients with diabetes and sepsis.These findings suggest that potassium management strategies should be specifically tailored for this high-risk patient population.
Keywords: Serum potassium, diabetes, Sepsis, ICU, Mortality, Hyperkalemia, Hypokalemia
Received: 25 Feb 2025; Accepted: 09 May 2025.
Copyright: © 2025 Cai, Zhang, Chen, Shu, Lin and Jin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Haijiao Jin, Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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