ArticleInternational journal of clinical pharmacy2026
Active surveillance and risk prediction of piperacillin/tazobactam‑associated hypokalaemia: development and external validation of a clinical nomogram.
Article in International journal of clinical pharmacy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPiperacillin/tazobactam (TZP) is widely used in hospitalised adults. Real‑world data suggest a higher risk of hypokalaemia than previously recognised.
aimTo investigate incidence, severity and risk factors of TZP‑induced hypokalaemia, and to develop and externally validate a nomogram for individualised risk prediction.
methodThis retrospective study included hospitalised adults receiving TZP (2021-2025). TZP‑induced hypokalaemia was defined as serum potassium < 3.5 mmol/L ≥ 48 h after TZP initiation. Logistic regression identified predictors. A nomogram was constructed. Model performance was assessed by discrimination (area under the ROC curve, AUC), calibration (Hosmer‑Lemeshow test, calibration intercept/slope), Brier score and decision‑curve analysis (DCA), with internal and external validation.
resultsAmong 643 patients, 122 (19.0%) developed TZP‑induced hypokalaemia (mild: 78.7%; moderate: 16.4%; severe: 4.9%). Median time to onset was 5.0 days. Independent predictors were age ≥ 65 years (OR = 2.118, 95% CI 1.003-4.472, p = 0.049), body mass index (OR = 0.671, 95% CI 0.591-0.762, p < 0.001), intensive care unit admission (OR = 2.915, 95% CI 1.504-5.651, p = 0.002), daily dose (OR = 1.280, 95% CI 1.110-1.476, p < 0.001), and baseline serum potassium (OR = 0.123, 95% CI 0.056-0.271, p < 0.001). The nomogram showed good discrimination (training AUC 0.881, internal 0.876, external 0.813), calibration (Hosmer‑Lemeshow p > 0.05), Brier scores < 0.25 and positive net benefit on DCA.
conclusionTZP‑induced hypokalaemia is common in hospitalised adults. A nomogram based on five readily available clinical variables may facilitate early identification of high‑risk patients, although prospective validation in diverse settings is required before clinical implementation.
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