Hyperkalaemia Following Blood Transfusion–a Systematic Review Assessing Evidence and Risks

Wolf, Julia; Geneen, Louise J; Meli, A.; Dorée, Carolyn; Cardigan, Rebecca; New, Helen

doi:10.1016/j.tmrv.2022.04.003

Cited by 3 publications

(4 citation statements)

References 49 publications

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“…It is also notable that none of the studies included in this review reported serum potassium concentrations, with raised concentrations being recognised as deleterious in traumatic coagulopathy it would be beneficial to quantify this in future studies [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

Hibberd,

Price,

Thomas

et al. 2024

PLoS ONE

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Objectives In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric patients are limited. The objectives of this review were to determine the incidence of admission ionised hypocalcaemia in paediatric major trauma patients and to explore whether hypocalcaemia is associated with adverse outcomes. Methods A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass’ D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05. Results Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane’s Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80–6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane’s Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27). Conclusion Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.

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Section: Discussionmentioning

confidence: 99%

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

Hibberd,

Price,

Thomas

et al. 2024

PLoS ONE

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“…Secondary outcomes are the associations with physiological abnormalities and adverse outcomes. Physiological abnormalities are classified dichotomously as the presence of hypotension (based on age-specific APLS values)30 or elevated SIPA (0–6 years: >1.22, 7–12 years: >1.00 and 13–16 years: >0.90),31 32 hyperkalaemia (>5.5 mmol/L)28 and hyperlactataemia (>2.0 mmol/L) 29. Adverse outcomes are classified dichotomously as the requirement for vasopressors, transfusion, activation of the major haemorrhage protocol or invasive (operative or interventional radiology) intervention in the first 24 hours and mortality within 30 days.…”

Section: Methodsmentioning

confidence: 99%

“…Definitions and presence of coagulopathy 10. The presence of hyperkalaemia (>5.5 mmol/L) 28 11. The presence of hyperlactataemia (>2.0 mmol/L) 29…”

Section: Study Recordsmentioning

confidence: 99%

Incidence of admission ionised hypocalcaemia in paediatric major trauma: protocol for a systematic review and meta-analysis

Hibberd,

Price,

Harris

et al. 2023

BMJ Open

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IntroductionHypocalcaemia forms part of the ‘diamond of death’ in major trauma, alongside hypothermia, acidosis and coagulopathy. In adults, admission hypocalcaemia prior to transfusion is associated with increased mortality, increased blood transfusion requirements and coagulopathy. Data on paediatric major trauma patients are limited. This systematic review and meta-analysis aims to describe and synthesise the available evidence relevant to paediatric trauma, admission hypocalcaemia and outcome.Methods and analysisThe Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. A planned literature search for articles in the English language will be conducted from inception to the date of searches using MEDLINE on the EBSCO platform, CINAHL on the EBSCO platform and Embase on the Ovid platform. The grey literature will also be searched. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. Heterogeneity will be assessed using the I2test, and the risk of bias will be assessed using the ROBINS-I tool. A meta-analysis will be undertaken using ratio measures (OR) and mean differences for measures of effect. When possible, the estimate of effect will be presented along with a CI and a p value.Ethical review and disseminationEthical review is not required, as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences.PROSPERO registration numberCRD42023425172.

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“…Hyperkalemia is another well-known complication of mass transfusion and, like hypocalcemia, can result from numerous mechanisms. Historically, irradiation of stored blood products, a technique used since the 1980s, works to inactivate donor T-lymphocyte, preventing the highly morbid graft-versus-host disease (11,12). However, irradiation causes instability of the cell membrane of the red blood cell, leading to elevated extracellular potassium (K + ).…”

Section: Introductionmentioning

confidence: 99%

Prospective Examination of the K/Ica Ratio as a Predictor for Mortality in Severe Hemorrhage

Gagen,

Duchesne,

Ghio

et al. 2023

Shock

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BACKGROUND Patients receiving massive transfusion protocol (MTP) are at risk for post-transfusion hypocalcemia and hyperkalemia. Previous retrospective analysis has suggested the potassium/ionized calcium (K/iCa) ratio as a prognostic indicator of mortality. This prospective study sought to validate the value of the K/iCa ratio as a predictor for mortality in patients receiving MTP. METHODS This was a prospective analysis of adult trauma patients who underwent MTP activation from May 2019 - March 2021 at an urban Level 1 trauma center. Serum potassium and ionized calcium levels within 0-1 hr of MTP initiation were used to obtain K/iCa. Receiver operator characteristic (ROC) curve analysis assessed predictive capacity of K/iCa on mortality. Kaplan-Meier survival analysis and Cox regression examined the effect of K/iCa ratio on survival. RESULTS A total of 110 of 300 MTP activation patients met inclusion criteria. Overall mortality rate was 31.8%. No significant differences between the elevated K/iCa and lower K/iCa groups were found for prehospital or Emergency Department initial vitals, shock index, or injury severity. However, non-survivors had a significantly higher median K/iCa ratio compared to those who survived (p < 0.01). Multivariable logistic regression revealed total number of blood products to be significantly associated with elevated K/iCa (odds ratio 1.02; 95%CI 1.01-1.04; p = 0.01). The KM survival curve demonstrated a significantly increased rate of survival for those with an elevated K/iCa ratio (p < 0.01). Multivariable Cox regression adjusted for confounders showed a significant association between K/iCa and mortality (HR 4.12, 95% CI 1.89 – 8.96, p < 0.001). CONCLUSION This evidence further highlights the importance of the K/iCa ratio in predicting mortality among trauma patients receiving MTP. Furthermore, it demonstrates that post-transfusion K levels along with iCa levels should be carefully monitored in the MTP setting. LEVEL OF EVIDENCE Level II STUDY TYPE Prognostic/Epidemiological

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Hyperkalaemia Following Blood Transfusion–a Systematic Review Assessing Evidence and Risks

Cited by 3 publications

References 49 publications

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

Incidence of admission ionised hypocalcaemia in paediatric major trauma: protocol for a systematic review and meta-analysis

Prospective Examination of the K/Ica Ratio as a Predictor for Mortality in Severe Hemorrhage

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