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The association between postoperative nadir serum potassium and mortality within 28-day after aortic valve

Haoran Zhang1, Shurui Zhang1, Shuyuxuan Song1

  • 1Shandong First Medical University, Ji'nan City, Shandong Province, China.

Journal of Cardiothoracic Surgery
|May 1, 2026
PubMed
Abstract

Insights

Lower postoperative nadir serum potassium levels are linked to higher 28-day mortality in surgical aortic valve replacement (SAVR) patients. Maintaining potassium above 3.5 mmol/L may reduce short-term mortality risk.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Nephrology

Background:

  • Postoperative serum potassium levels are critical in cardiac surgery patients.
  • Understanding the association between nadir potassium and mortality after SAVR is essential for patient management.

Purpose of the Study:

  • To investigate the relationship between postoperative nadir serum potassium and 28-day mortality in patients undergoing SAVR.
  • To identify potential thresholds for serum potassium that impact short-term survival.

Main Methods:

  • Retrospective cohort study of 2,877 patients undergoing SAVR from the MIMIC-IV database.
  • Logistic regression and restricted cubic spline analysis were used to assess the association between nadir potassium and 28-day mortality.
  • Kaplan-Meier survival curves were employed to compare mortality risks.

Main Results:

  • A U-shaped relationship was found between postoperative nadir potassium and 28-day mortality.
  • Higher nadir potassium levels were associated with significantly reduced mortality (OR=0.40, p<0.001).
  • An optimal threshold of 3.55 mmol/L was identified, with levels below this associated with increased mortality risk.

Conclusions:

  • Lower postoperative nadir serum potassium is an independent predictor of increased 28-day mortality in SAVR patients.
  • Maintaining postoperative nadir serum potassium above 3.5 mmol/L may be associated with reduced short-term mortality.
  • The nadir value should not be considered a target, as it represents the lowest single measurement and not overall potassium balance.
Keywords:
Aortic valve replacementHypokalemiaMIMIC-ⅣNadir serum potassium

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