Coronavirus disease 2019 (COVID-19) use Angiotensin-Converting Enzyme 2 (ACE-2) as a viral gateway and could have interactions with the RAA system. Other studies have found kalemia abnormalities associated with severe forms of COVID-19.Our goal was to assess the prognosis value of kalemia in severe COVID-19 hospitalized population.

We analyzed data from a monocentric prospective observational cohort that included 65 patients PCR-confirmed positive for COVID-19 who were admitted at HEGP in Paris, between 15 to 21 March, 2020. The study aimed to determine the relationship between baseline kalemia and the primary composite outcome defined as admission to an intensive care unit (ICU) or death. Baseline kalemia was defined as the presence of a kalemia under 3.8mmol/L within 10 days of the first symptom onset.

We included 65 patients with PCR COVID-19 positive test. Median age was 65 years old and 66.2% were male. Baseline kalemia under 3.8mmol/l occurred in 31 patients (48%) including 11 patients (35.5%) who were hospitalized in ICU and 1 patient (3.2%) who died before ICU admission. In the primary end-point analysis based on multiple imputations for missing data, the adjusted hazard ratios for admission to ICU or death were 3.52 [95%(CI), 1.12 to 11.04] among patients who presented a kalemia under 3.8mmol/L within 10 days of the first symptom onset. Moreover, we did find an adjusted association between baseline kalemia and the minimum hemoglobin level presented by the patients during the hospital stay (odds ratio, 0.80; 95% CI, 0.64 to 0.99) (Fig. 1).

Our study suggests that the presence of a kalemia under 3.8mmol/L within 10 days of the first symptom onset might be associated with an increased risk of intensive care unit or death, and the minimum hemoglobin level presented by the patients during the hospital stay. Future intervention studies aimed for correcting this hypokalemia with ARBs to improve prognosis are ongoing.