Kalemia Significantly Influences Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)

Objective: Potassium levels (KLs) influence clinical outcomes in severe traumatic brain injury (TBI). This study investigates the relationship between KLs and clinical outcomes to improve prognosis and guide management. Method: A retrospective study was conducted at a level 1 trauma center in Queens, New York, from January 2020 to December 2023. Patients with an AIS score of 3 or higher were included. KLs were measured at the time of hospital admission, ICU admission, ICU discharge, hospital discharge, and death, if applicable. Clinical outcomes such as age, race, length of hospital stay (H LOS), ICU length of stay (ICU LOS), ventilation days (VDs), Glasgow Coma Scale (GCS), and mortality were assessed. Results: KLs were categorized into five groups: extreme hypokalemia (<2.5 mEq/L), hypokalemia (2.6-3.5 mEq/L), normokalemia (3.5-5.2 mEq/L), hyperkalemia (5.2-7.0 mEq/L), and extreme hyperkalemia (>7.0 mEq/L). Significant correlations were observed between KLs at hospital admission and age (p = 0.0113), race (p = 0.003), and H LOS (p = 0.079). ICU KLs showed positive correlations with AIS head score (p = 0.038), ISS (p = 7.84 × 10^-6), and GCS (p = 2.6 × 10^-6). ICU KLs were also associated with LOS in the Emergency Department (ED) (p = 6.875 × 10^-6) and ICU (p = 1.34 × 10^-21), as well as VDs (p = 7.19 × 10^-7). ICU discharge KLs correlated with ISS (p = 2.316 × 10^-3), GCS (p = 2.201 × 10^-3), ED LOS (p = 3.163 × 10^-4), and VDs (p = 7.44 × 10^-4). KLs at discharge were linked with mortality (p < 0.0001) and H LOS (p = 0.0091). Additionally, KLs at the time of death were correlated with ISS (p = 0.01965), GCS (p = 0.01219), ED LOS (p = 0.00594), ICU LOS (p = 0.049), VDs (p = 0.00005), and mortality (p < 0.0001). Conclusions: Potassium imbalances, especially hypokalemia, significantly affect outcomes in severe TBI patients. Monitoring and managing KLs may improve prognosis.