Abstract
BACKGROUND: Liver dysfunction, which serves as a critical indicator of advanced liver disease and a driver of mortality in PLWH, is frequently accompanied by perturbations in serum potassium homeostasis. This study aims to investigate the association between serum potassium and liver dysfunction in PLWH, with identifying potential indicative value for risk stratification of hepatic outcomes. METHODS: A total of 2,725 PLWHs, with 10,718 measurements of serum potassium, were enrolled in this study. Piecewise linear mixed-effect model with smoothing function and Cox regression analysis were used to identify the association of serum potassium with liver dysfunction. RESULTS: A U-shaped relationship was identified between serum potassium and liver dysfunction, with a threshold of 4.25 mmol/L. Participants with baseline potassium > 4.25 mmol/L had a 27% (95% CI: 1.04–1.54) higher risk of mild liver dysfunction and a 48% (95% CI: 1.01–2.14) higher risk of severe liver dysfunction, which were confirmed by Kaplan-Meier analyses. CONCLUSIONS: The study establishes serum potassium concentration as an independent predictor of liver dysfunction in PLWHs, highlighting the importance of potassium monitoring and management for this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12981-025-00766-0.