J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 10, October 2026, pages 728-736

Diabetes Mellitus Independently Predicts Survival in Beta-Lactam-Associated Hypokalemia

↓ Figure 1. Key results of the survival analysis. Deceased individuals had a lower minimum eGFR (a), a higher peak CRP (b), and suffered more from COPD (c) but less from diabetes mellitus (d). (e, f) AUC of the two logistic regression models.

↓ **Table 1.** Patient Characteristics
Variable	NBLA	HBLA	P-value
*P < 0.05 (statistical significance). AF: atrial fibrillation; BMI: body mass index; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; HBLA: hypokalemia under beta-lactam therapy; HF: heart failure; NBLA: normokalemia under beta-lactam therapy; SD: standard deviation.
Age, years (mean ± SD)	69.4 ± 1.5	73.9 ± 0.9	0.05
Gender, female (%)	32.3	46	0.015*
In-hospital therapy, days (mean ± SD)	13 ± 0.9	19.3 ± 0.8	< 0.001*
BMI, kg/m² (mean ± SD)	27.2 ± 0.6	27.2 ± 0.5	0.9
In-hospital survival (%)	96	87.4	0.01*
Administration of diuretics (%)	39.5	57.6	0.002*
Diarrhea (%)	2.4	7.6	0.05
Polyuria, not induced by diuretics (%)	0	1	0.99
Dehydration (%)	18.5	21.2	0.56
Morbidities (%)
Cirrhosis	0.8	9.6	0.001*
Arterial hypertension	78.2	82.8	0.35
CAD	21.8	22.7	0.8
HF	22.6	40.4	< 0.001*
AF	15.3	34.3	< 0.001*
COPD	17.7	19.2	0.75
DM	26.6	36.9	0.05
Obesity	75.8	73.7	0.67
History of neoplasia	23.4	27.3	0.43
Smoking (%)	91.1	86.3	0.19
Laboratory findings
Initial serum sodium, mmol/L (mean ± SD)	136.2 ± 0.4	136.6 ± 0.4	0.36
Minimal serum sodium, mmol/L (mean ± SD)	135.5 ± 0.4	133.7 ± 0.3	< 0.001*
Serum sodium at discharge, mmol/L (mean ± SD)	139.2 ± 0.3	140.3 ± 0.4	0.19
Initial eGFR, mL/min (mean ± SD)	64 ± 2.7	60 ± 2	0.29
Minimal eGFR, mL/min (mean ± SD)	59.1 ± 2.8	49.8 ± 2.1	0.01*
eGFR at discharge, mL/min (mean ± SD)	67.6 ± 2.9	72.2 ± 2.2	0.29
Initial CRP, mg/L (mean ± SD)	85.5 ± 7.9	101.9 ± 7.7	0.41
Peak CRP, mg/L (mean ± SD)	131.1 ± 8.4	185.3 ± 7.5	< 0.001*
CRP at discharge, mg/L (mean ± SD)	38.3 ± 3.5	56.6 ± 4.2	0.01*

↓ Table 1. Patient Characteristics

Variable

NBLA

HBLA

P-value

*P < 0.05 (statistical significance). AF: atrial fibrillation; BMI: body mass index; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; HBLA: hypokalemia under beta-lactam therapy; HF: heart failure; NBLA: normokalemia under beta-lactam therapy; SD: standard deviation.

Age, years (mean ± SD)

69.4 ± 1.5

73.9 ± 0.9

0.05

Gender, female (%)

32.3

0.015*

In-hospital therapy, days (mean ± SD)

13 ± 0.9

19.3 ± 0.8

< 0.001*

BMI, kg/m² (mean ± SD)

27.2 ± 0.6

27.2 ± 0.5

0.9

In-hospital survival (%)

87.4

0.01*

Administration of diuretics (%)

39.5

57.6

0.002*

Diarrhea (%)

2.4

7.6

0.05

Polyuria, not induced by diuretics (%)

0.99

Dehydration (%)

18.5

21.2

0.56

Morbidities (%)

Cirrhosis

0.8

9.6

0.001*

Arterial hypertension

78.2

82.8

0.35

CAD

21.8

22.7

0.8

22.6

40.4

< 0.001*

15.3

34.3

< 0.001*

COPD

17.7

19.2

0.75

26.6

36.9

0.05

Obesity

75.8

73.7

0.67

History of neoplasia

23.4

27.3

0.43

Smoking (%)

91.1

86.3

0.19

Laboratory findings

Initial serum sodium, mmol/L (mean ± SD)

136.2 ± 0.4

136.6 ± 0.4

0.36

Minimal serum sodium, mmol/L (mean ± SD)

135.5 ± 0.4

133.7 ± 0.3

< 0.001*

Serum sodium at discharge, mmol/L (mean ± SD)

139.2 ± 0.3

140.3 ± 0.4

0.19

Initial eGFR, mL/min (mean ± SD)

64 ± 2.7

60 ± 2

0.29

Minimal eGFR, mL/min (mean ± SD)

59.1 ± 2.8

49.8 ± 2.1

0.01*

eGFR at discharge, mL/min (mean ± SD)

67.6 ± 2.9

72.2 ± 2.2

0.29

Initial CRP, mg/L (mean ± SD)

85.5 ± 7.9

101.9 ± 7.7

0.41

Peak CRP, mg/L (mean ± SD)

131.1 ± 8.4

185.3 ± 7.5

< 0.001*

CRP at discharge, mg/L (mean ± SD)

38.3 ± 3.5

56.6 ± 4.2

0.01*

↓ **Table 2.** All Variables Compared Between Surviving and Deceased Patients With Hypokalemia on Beta-Lactam Therapy
Variable	Survival	Death	P-value
*P < 0.05 (statistical significance). A total of five significant differences between the two cohorts were identified, and four variables were included in the logistic regression analysis. AF: atrial fibrillation; BMI: body mass index; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; HF: heart failure; SD: standard deviation.
Age, years (mean ± SD)	73.4 ± 1	77.4 ± 2.1	0.27
Gender, female (%)	46.8	40	0.52
in-hospital therapy, days (mean ± SD)	19.6 ± 0.9	17.2 ± 1.5	0.73
BMI, kg/m² (mean ± SD)	27.4 ± 0.6	26 ± 1.3	0.39
Administration of diuretics (%)	56	57.8	0.86
Diarrhea (%)	8.7	0	0.12
Polyuria, not induced by diuretics (%)	1.2	0	0.58
Dehydration (%)	21.4	20	0.87
Morbidities (%)
Cirrhosis	8.7	16	0.24
Arterial hypertension	83.2	80	0.68
CAD	20.8	36	0.09
HF	42.2	28	0.17
AF	34.1	36	0.85
COPD	16.8	36	0.02*
DM	40.5	12	0.006*
Obesity	73.4	76	0.78
History of neoplasia	24.3	48	0.013*
Smoking (%)	13.4	16	0.72
Laboratory findings
Minimal serum potassium, mmol/L (mean ± SD)	3.14 ± 0.02	3.16 ± 0.05	0.65
Initial serum sodium, mmol/L (mean ± SD)	136.5 ± 0.4	137.3 ± 1.2	0.53
Minimal serum sodium, mmol/L (mean ± SD)	133.8 ± 0.4	133.1 ± 1	0.34
Serum sodium at discharge, mmol/L (mean ± SD)	139.8 ± 2.2	143.7 ± 2.2	0.36
Initial eGFR, mL/min (mean ± SD)	61.2 ± 2.2	51.4 ± 5.5	0.14
Minimal eGFR, mL/min (mean ± SD)	51.5 ± 2.2	37.7 ± 5.7	0.019*
eGFR at discharge, mL/min (mean ± SD)	73.1 ± 2.3	66.8 ± 7.3	0.51
Initial CRP, mg/L (mean ± SD)	98.9 ± 8	122 ± 25	0.42
Peak CRP, mg/L (mean ± SD)	179.8 ± 7.8	222.7 ± 23.4	0.06
CRP at discharge, mg/L (mean ± SD)	45.4 ± 3.3	129.8 ± 17.6	< 0.001*

↓ Table 2. All Variables Compared Between Surviving and Deceased Patients With Hypokalemia on Beta-Lactam Therapy

Variable

Survival

Death

P-value

*P < 0.05 (statistical significance). A total of five significant differences between the two cohorts were identified, and four variables were included in the logistic regression analysis. AF: atrial fibrillation; BMI: body mass index; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; HF: heart failure; SD: standard deviation.

Age, years (mean ± SD)

73.4 ± 1

77.4 ± 2.1

0.27

Gender, female (%)

46.8

0.52

in-hospital therapy, days (mean ± SD)

19.6 ± 0.9

17.2 ± 1.5

0.73

BMI, kg/m² (mean ± SD)

27.4 ± 0.6

26 ± 1.3

0.39

Administration of diuretics (%)

57.8

0.86

Diarrhea (%)

8.7

0.12

Polyuria, not induced by diuretics (%)

1.2

0.58

Dehydration (%)

21.4

0.87

Morbidities (%)

Cirrhosis

8.7

0.24

Arterial hypertension

83.2

0.68

CAD

20.8

0.09

42.2

0.17

34.1

0.85

COPD

16.8

0.02*

40.5

0.006*

Obesity

73.4

0.78

History of neoplasia

24.3

0.013*

Smoking (%)

13.4

0.72

Laboratory findings

Minimal serum potassium, mmol/L (mean ± SD)

3.14 ± 0.02

3.16 ± 0.05

0.65

Initial serum sodium, mmol/L (mean ± SD)

136.5 ± 0.4

137.3 ± 1.2

0.53

Minimal serum sodium, mmol/L (mean ± SD)

133.8 ± 0.4

133.1 ± 1

0.34

Serum sodium at discharge, mmol/L (mean ± SD)

139.8 ± 2.2

143.7 ± 2.2

0.36

Initial eGFR, mL/min (mean ± SD)

61.2 ± 2.2

51.4 ± 5.5

0.14

Minimal eGFR, mL/min (mean ± SD)

51.5 ± 2.2

37.7 ± 5.7

0.019*

eGFR at discharge, mL/min (mean ± SD)

73.1 ± 2.3

66.8 ± 7.3

0.51

Initial CRP, mg/L (mean ± SD)

98.9 ± 8

122 ± 25

0.42

Peak CRP, mg/L (mean ± SD)

179.8 ± 7.8

222.7 ± 23.4

0.06

CRP at discharge, mg/L (mean ± SD)

45.4 ± 3.3

129.8 ± 17.6

< 0.001*

↓ **Table 3.** Results of the Logistic Regression Analysis
Variable	Odds ratio	95% CI
Two models were used, the only difference between the models was the inclusion of either COPD (model 1) or diabetes mellitus (model 2) as an independent variable. In both models, age, sex, use of diuretics, and the minimum eGFR during inpatient treatment were defined as additional independent variables. CI: confidence interval; COPD: chronic obstructive pulmonary disease; eGFR: estimated glomerular filtration rate.
Model 1: endpoint – survival; variables - age, gender, diuretics in use, minimal eGFR, COPD
Age	1.017	0.9803 to 1.059
Female gender	0.5758	0.2213 to 1.424
Diuretics	0.5811	0.2288 to 1.481
Minimal eGFR	0.9784	0.9598 to 0.9960
COPD	3.318	1.246 to 8.605
Model 2: endpoint – survival; variables - age, gender, diuretics in use, minimal eGFR, diabetes mellitus
Age	1.015	0.9776 to 1.058
Female gender	0.5825	0.2256 to 1.434
Diuretics	0.6105	0.2421 to 1.549
Minimal eGFR	0.9803	0.9609 to 0.9986
(no) diabetes mellitus	4.805	1.556 to 21.11

↓ Table 3. Results of the Logistic Regression Analysis

Variable

Odds ratio

95% CI

Two models were used, the only difference between the models was the inclusion of either COPD (model 1) or diabetes mellitus (model 2) as an independent variable. In both models, age, sex, use of diuretics, and the minimum eGFR during inpatient treatment were defined as additional independent variables. CI: confidence interval; COPD: chronic obstructive pulmonary disease; eGFR: estimated glomerular filtration rate.

Model 1: endpoint – survival; variables - age, gender, diuretics in use, minimal eGFR, COPD

Age

1.017

0.9803 to 1.059

Female gender

0.5758

0.2213 to 1.424

Diuretics

0.5811

0.2288 to 1.481

Minimal eGFR

0.9784

0.9598 to 0.9960

COPD

3.318

1.246 to 8.605

Model 2: endpoint – survival; variables - age, gender, diuretics in use, minimal eGFR, diabetes mellitus

Age

1.015

0.9776 to 1.058

Female gender

0.5825

0.2256 to 1.434

Diuretics

0.6105

0.2421 to 1.549

Minimal eGFR

0.9803

0.9609 to 0.9986

(no) diabetes mellitus

4.805

1.556 to 21.11