Indicators for predicting continuous insulin infusion therapy-related hypokalemia: multicenter retrospective cohort...

Hypokalemia is a common and potentially life-threatening complication of continuous intravenous insulin infusion (CII) in patients with hyperglycemic crises. However, no simple quantitative indicator can estimate the risk of hypokalemia at treatment initiation. This multicenter retrospective cohort study enrolled patients hospitalized for hyperglycemic crises who received CII. Clinical data available at CII initiation were collected. Machine-learning techniques were primarily employed for feature selection and model comparison to develop a simple, clinically interpretable prediction model. A logistic regression-based indicator was constructed using the most contributory variables and validated internally and externally. Hypokalemia was defined as a serum potassium level <3.5 mmol/L. The model-building and external validation cohorts included 99 and 55 patients, respectively. Among multiple candidate models, a lightweight logistic regression model using only two variables, serum potassium level and insulin infusion rate per body weight, was selected for clinical applicability. In internal validation, the model demonstrated good discriminative performance (receiver operating characteristic-area under the curve [ROC-AUC] 0.821). When applied to the external validation cohort, the ROC-AUC was 0.655, and accuracy decreased slightly. A lower threshold may increase sensitivity in screening, whereas a higher threshold may improve specificity. In conclusion, this study presents a simple and clinically applicable indicator for predicting CII-related hypokalemia using only two routinely available variables at treatment initiation. This model supports individualized electrolyte monitoring during the acute management of hyperglycemic crises. Additionally, it may facilitate safer and more efficient clinical decision-making without reliance on complex algorithms.