Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function

Media type: E-Article
Title: Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function
Contributor: Breidthardt, Tobias; Weidmann, Zoraida Moreno; Twerenbold, Raphael; Gantenbein, Claudine; Stallone, Fabio; Rentsch, Katharina; Rubini Gimenez, Maria; Kozhuharov, Nikola; Sabti, Zaid; Breitenbücher, Dominik; Wildi, Karin; Puelacher, Christian; Honegger, Ursina; Wagener, Max; Schumacher, Carmela; Hillinger, Petra; Osswald, Stefan; Mueller, Christian
imprint: Wiley, 2017
Published in: European Journal of Heart Failure
Language: English
DOI: 10.1002/ejhf.667
ISSN: 1388-9842; 1879-0844
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title><jats:sec><jats:title>Aims</jats:title><jats:p>Treatment goals in acute heart failure (<jats:styled-content style="fixed-case">AHF</jats:styled-content>) are poorly defined. We aimed to characterize further the impact of in‐hospital haemoconcentration and worsening renal function (<jats:styled-content style="fixed-case">WRF</jats:styled-content>) on short‐ and long‐term mortality.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>Haematocrit, haemoglobin, total protein, serum creatinine, and albumin levels were measured serially in 1019 prospectively enrolled <jats:styled-content style="fixed-case">AHF</jats:styled-content> patients. Haemoconcentration was defined as an increase in at least three of four of the haemoconcentration‐defining parameters above admission values at any time during the hospitalization. Patients were divided into early (Day 1–4) and late haemoconcentration (>Day 4). Ninety‐day mortality was the primary endpoint. Haemoconcentration occurred in 392 (38.5%) patients, with a similar incidence of the early (44.6%) and late (55.4%) phenotype. Signs of decongestion (reduction in <jats:styled-content style="fixed-case">BNP</jats:styled-content> blood concentrations, <jats:italic>P</jats:italic> = 0.003; weight loss, <jats:italic>P</jats:italic> = 0.002) were significantly more pronounced in haemoconcentration patients. <jats:styled-content style="fixed-case">WRF</jats:styled-content> was more common in haemoconcentration patients (<jats:italic>P</jats:italic> = 0.04). After adjustment for established risk factors for <jats:styled-content style="fixed-case">AHF</jats:styled-content> mortality, including <jats:styled-content style="fixed-case">WRF</jats:styled-content> and <jats:styled-content style="fixed-case">HF</jats:styled-content> therapy at discharge, haemoconcentration was significantly associated with a reduction in 90‐day mortality [hazard ratio (<jats:styled-content style="fixed-case">HR</jats:styled-content>) 0.59, 95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) 0.37–0.95, <jats:italic>P</jats:italic> = 0.01]. The beneficial effect of haemoconcentration seemed to be exclusive for late haemoconcentration (late vs. early: adjusted <jats:styled-content style="fixed-case">HR</jats:styled-content> 0.41, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.19–0.90, <jats:italic>P</jats:italic> = 0.03) and persisted in patients with or without <jats:styled-content style="fixed-case">WRF</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Haemoconcentration represents an inexpensive and easily assessable pathophysiological signal of adequate decongestion in <jats:styled-content style="fixed-case">AHF</jats:styled-content> and is associated with lower mortality. <jats:styled-content style="fixed-case">WRF</jats:styled-content> in the setting of haemoconcentration does not appear to offset the benefits of haemoconcentration.</jats:p></jats:sec>
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