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Hemoconcentration in order to avoid readmissions in heart failure: wich laboratory markers to use?
Session:
Painel 1 - Insuficiência Cardíaca 9
Speaker:
Pedro Morais
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Morais; Catarina Duarte; João Pedro Ribeiro Agostinho; Joana Brito; Sara Couto Pereira; Pedro Silvério António; Rafael Santos; Joana Rigueira; Inês Aguiar Ricardo; Maria Mónica Mendes Pedro; Fátima Veiga; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction</strong>: Hemoconcentration is a widely accepted prognostic marker associated with improvement of short-term mortality and rehospitalization in acute heart failure (HF). Different laboratory markers are used as surrogates of hemoconcentration. However the best laboratory surrogate marker is not yet defined.</p> <p><strong>Methods</strong>: Single-center, retrospective study of 224 consecutive patients admitted for acute HF between 2016 and 2018. Hemoglobin (Hb), hematocrit (Hct), sodium (Na+) creatinine (Cr) and estimated plasma volume (ePV; calculated using the Strauss formula) were selected as laboratory surrogates of hemoconcentration. Blood samples were obtained at admission and at discharge. Variation of each one of these markers were also calculated (ΔCr, ΔNa+, ΔHct and ΔHb).</p> <p>Cox regression was used to evaluate the impact of the above-mentioned variables in 1-year all cause hospitalisation, HF hospitalisation, death and in the combined outcome of all cause hospitalisation or death. The analysis was adjusted for age, HF aetiology, NYHA functional class and left ventricule ejection fraction (EF).</p> <p><strong>Results</strong>: The study included 224 patients (63.8% male, mean age of 71.7±13.4 years). The most frequent aetiologies were ischaemic heart disease (39.7%) and dilated cardiomyopathy (22.3%). The vast majority of patients were in NYHA class II (23.9%) and III (33.4%). HF with reduced EF was present in 62.2% patients, with preserved EF in 23.0% and with mid-range EF in 14.8%. HF admission rate was 29.5%. All cause admission rate was 12.1%.</p> <p>At admission, mean blood test results were as follows: Hb 12.7±2.1g/dL, Hct 38.7±6.2%, Cr 1.42±0.95mg/dL, Na+ 138.2±5.1mmol/L, ePV 5.1±1.6L. At discharge: Hb 12.6±2.1g/dL, Hct 38.4±6.8%, Cr 1.34±0.79mg/dL, Na+ 137±10.2mmol/L, ePV 4.9±1.8L.</p> <p>In multivariate analysis, the only surrogate marker of hemoconcentration with a protective effect on HF hospitalisation was ΔHct (OR 1.04; CI 95% 1.01-1.09; p=0.024).</p> <p>Hct variation was also found to be a protective factor for the combined outcome of all cause hospitalisation, HF hospitalisation and death (OR 1.03; CI 95% 1.01-1.06; p=0.034). None of the remaining surrogate markers analysed were found to be useful on predicting adverse events.</p> <p>No surrogate for hemoconcentration was associated with death alone or all cause admission.</p> <p>A Kaplan-Meier survival analysis found that a ΔHct >2.9% (fourth quartile) is associated with a greater protective effect for HF admissions (figure 1).</p> <p><strong>Conclusions</strong>: The only surrogate marker of hemoconcentration that consistently seems to be associated with lower heart failure admission rate is a positive hematocrit variation at discharge, particularly when > 2.9 %.</p>
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