Predictors of High-Risk Arrhythmic ECG Patterns in Hospitalized Patients with Electrolyte Disturbances

Muskan Sharma; Ayush Patel; Charishma Parla; Shaurya Thakur; Mah-e-Tab Rai

Predictors of High-Risk Arrhythmic ECG Patterns in Hospitalized Patients with Electrolyte Disturbances

Author(s)	Muskan Sharma, Ayush Patel, Charishma Parla, Shaurya Thakur, Mah-e-Tab Rai
Country	India
Abstract	Background Electrolyte abnormalities are common among hospitalized patients and are known to influence myocardial conduction and repolarization, thereby increasing the risk of cardiac arrhythmias. Potassium, calcium, and magnesium disturbances in particular have been associated with characteristic electrocardiographic changes and adverse clinical outcomes. However, data from general medical wards in low- and middle-income settings remain limited. Objectives To determine the prevalence of high-risk arrhythmic electrocardiographic patterns among hospitalized adults with electrolyte disturbances and to identify independent clinical and biochemical predictors of these abnormalities. Methods A cross-sectional study was conducted among adult inpatients who underwent same-day serum electrolyte testing and 12-lead electrocardiography. Abnormalities in sodium, potassium, calcium, and magnesium levels were defined using standardized laboratory thresholds. Electrocardiograms were systematically evaluated for predefined arrhythmogenic patterns. Multivariable logistic regression analysis was used to identify independent predictors of abnormal ECG findings. Results Among 412 participants (median age: 56 years; 48% female), at least one electrolyte abnormality was present in 61%. High-risk ECG patterns were detected in 34% of the overall cohort and in 49% of patients with biochemical disturbances. The most frequent abnormalities were QTc prolongation (18%), hypokalemia-related changes (12%), and hyperkalemia-related patterns (8%). After adjustment for confounding variables, hyperkalemia (adjusted odds ratio [aOR] 3.2; 95% CI 1.9–5.4), hypokalemia (aOR 2.1; 95% CI 1.3–3.5), and hypocalcemia (aOR 1.8; 95% CI 1.1–2.9) remained independently associated with abnormal ECG findings. Multiple concurrent electrolyte abnormalities and chronic kidney disease further increased risk. Conclusions High-risk arrhythmic ECG patterns are frequently observed among hospitalized patients with electrolyte disturbances. Integration of routine electrocardiographic assessment with biochemical monitoring may facilitate early detection of electrophysiological instability and guide timely clinical intervention.
Keywords	electrolyte imbalance, ECG, hyperkalemia, hypokalemia, hypocalcemia, hypomagnesemia, cross sectional study, medicine ward.
Field	Medical / Pharmacy
Published In	Volume 7, Issue 1, January-February 2026
Published On	2026-02-24

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Predictors of High-Risk Arrhythmic ECG Patterns in Hospitalized Patients with Electrolyte Disturbances

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