Abstract: TH-PO0080
Association of Rewarming Hyperkalemia with Clinical Outcomes in Patients After Cardiac Arrest Undergoing Targeted Temperature Management
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Yang, Tzu Hsien, Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
- Lin, Shih-Hua, Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
Background
Although dyskalemia is a common complication of targeted temperature management (TTM) for comatose out-of-hospital cardiac arrest (OHCA), the prognostic implications of rewarming hyperkalemia remain under-investigated. This study sought to determine the association between rewarming peak potassium (K+) levels and clinical outcomes in OHCA patients.
Methods
In this single-center retrospective cohort (January 2018-June 2025) of adults with non-traumatic OHCA undergoing TTM (34 °C, 24 hours), rewarming peak K+ was the highest plasma K+ during rewarming (34-36 °C). The primary cutoff was ≥ 5.0 mmol/L. Outcomes were 30-day in-hospital mortality (primary), major adverse kidney events within 30 days (MAKE30), and poor neurological outcome (Cerebral Performance Category 3-5). Multivariable logistic regression adjusted for hemoglobin, pre-rewarming creatinine, troponin-I, and resuscitation duration, using Firth's penalized likelihood for complete separation; sensitivity analyses used alternative cutoffs (4.5-5.5 mmol/L) and continuous modeling. Discriminative ability of rewarming peak K+ versus pre-rewarming K+ was compared using DeLong's paired test.
Results
Among 77 patients (75% male; 44% shockable; median resuscitation 20 [IQR 10-34] minutes), in-hospital mortality, MAKE30, and poor neurological outcome occurred in 34%, 43%, and 66%, respectively. Patients with rewarming hyperkalemia (≥ 5.0 mmol/L; n = 13) had universally fatal outcomes (mortality 100%); Firth's regression confirmed independent associations with mortality (aOR 66.25, 95% CI 3.20-1371.49, p = 0.007) and MAKE30 (aOR 34.70, 95% CI 1.34-901.42, p = 0.033). Sensitivity analyses across alternative thresholds and continuous modeling were consistent (per 0.5 mmol/L: mortality aOR 3.21, 95% CI 1.58-6.51, p = 0.001; MAKE30 aOR 2.96, 95% CI 1.42-6.20, p = 0.004). Rewarming peak K+ discriminated mortality with an AUC of 0.832 (95% CI 0.727-0.937), markedly outperforming pre-rewarming K+ (AUC 0.464; DeLong p < 0.001) and similarly outperforming it for MAKE30 (AUC 0.819 vs 0.480, p < 0.001). ΔK was substantially greater in non-survivors than survivors (1.35 vs 0.70 mmol/L, p < 0.001).
Conclusion
Rewarming peak potassium independently predicts mortality and adverse renal outcomes in OHCA patients treated with TTM.
Acknowledgment
We thank the ICU nursing staff and clinical research team for their assistance in data collection.
Funding
- Clinical Revenue Support