Serum Urea and Creatinine Levels are Better Predictors of Mortality than Serum Potassium Levels in Chronic Digoxin Toxicity
DOI:
https://doi.org/10.17140/EMOJ-4-147Keywords:
Digoxin toxicity, mortality, potassium, creatinine, ureaAbstract
Objective
Hyperpotassemia is known to have critical importance in acute digoxin intoxication. However, few studies have focused on the effects of serum urea, creatinine and potassium levels on the clinical prognosis of chronic digoxin intoxication. Our aim in this study was to investigate the relationship between serum urea, creatinine and potassium levels and mortality in patients with chronic digoxin toxicity.
Methods
Between January 2010 and May 2015, patients with chronic digoxin toxicity with serum digoxin levels of 2 ng/mL and above were screened retrospectively. Patients were divided into two groups according to their serum digoxin levels; Group 1 consisted of patients with digoxin levels between 2-4.9 ng/mL, Group 2 consisted of patients with digoxin levels of 5 ng/mL and above. The relationship between serum potassium, urea and creatinine levels and mortality was examined.
Results
Of the 307 patients were included, 10.1% (n = 31) were found to have died. In the analysis of survivors and non-survivors, the areas under the receiver operating characteristic curve were found to be 0.64, 0.73, 0.66 and 0.83 for serum digoxin, urea, creatinine and potassium values, respectively. The odds ratios calculated for the determined cut-off values were 2.8 for digoxin≥3.05 ng/mL, 4.8 for potassium≥5 mmol/L, 9.7 for creatinine≥1.75 mg/dL and 9.4 for urea≥100 mg/dL.
Conclusion
In patients with chronic digoxin toxicity, serum urea and creatinine values predict mortality better than serum potassium and digoxin levels.
References
See I, Shehab N, Kegler SR, et al. Emergency depart-ment visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010. Circ Heart Fail. 2014; 7(1): 28-34. DOI: 10.1161/ CIRCHEARTFAILURE.113.000784
Digitalis (cardiac glycoside) poisoning. Website. https:// www.uptodate.com/contents/digitalis-cardiac-glycoside-poisoning?source=search_result&search=Digitalis%20(car-diac%20glycoside)%20poisoning&selectedTitle=1~150. Ac-cessed.
Goldberger ZD, Goldberger AL. Therapeutic ranges of serum digoxin concentrations in patients with heart fail-ure. Am J Cardiol. 2012; 109(12): 1818-21. DOI: 10.1016/j.amj-card.2012.02.028
Kanji S, MacLean RD. Cardiac glycoside toxicity: more than 200 years and counting. Crit Care Clin. 2012; 28(4): 527-535. DOI: 10.1016/j.ccc.2012.07.005
Mahdyoon H, Battilana G, Rosman H, et al. The evolv-ing pattern of digoxin intoxication: Observations at a large urban hospital from 1980 to 1988. Am Heart J. 1990; 120(5): 1189-1194.
Bismuth C, Gaultier M, Conso F, et al. Hyperkalemia in acute digitalis poisoning: Prognostic significance and thera-peutic implications. Clin Toxicol (Phila). 1973; 6(2): 153-162. DOI: 10.3109/15563657308990513
Wenger TL, Butler Jr VP, Haber E, et al. Treatment of 63 severely digitalistoxic patients with digoxin-specific antibody frag-Research | Volume 4 | Issue 1| ments. J Am Coll Cardiol. 1985; 5(5 Suppl. A): 118A-123A.
Manini AF, Nelson LS, Hoffman RS. Prognostic util-ity of serum potassium in chronic digoxin toxicity: A case-con-trol study. Am J Cardiovasc Drugs. 2011; 11(3): 173-178. DOI: 10.2165/11590340-000000000-00000
Vamos M, Erath JW, Hohnloser SH. Digoxin-associated mortality: A systematic review and meta-analysis of the literature. Eur Heart J. 2015; 36(28): 1831-1838. DOI: 10.1093/eurheartj/ ehv143 Research | Volume 4 | Issue 1| Kilic TY, et al
Ordog GJ, Benaron S, Bhasin V, et al. Serum digoxin lev-els and mortality in 5100 patients. Ann Emerg Med. 1987; 16(1): 32-39.
Rathore SS, Curtis JP, Wang Y, et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA. 2003; 289(7): 871-878.
Chan KE, Lazarus JM, Hakim RM. Digoxin associates with mortality in ESRD. J Am Soc Nephrol. 2010; 21(9): 1550-1559. DOI: 10.1681/ASN.2009101047
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