Change in plasma volume and prognosis in acute decompensated heart failure: an observational cohort study

Abstract

Objectives This study aimed to develop an inexpensive, readily available prognostic indicator in acute decompensated heart failure patients to guide management and improve outcome. Prognostic biomarkers for heart failure exist but are expensive and not routinely performed. Increasing plasma volume has been associated with worse outcomes. Setting UK University Teaching Hospital. Design Observational Cohort study. Participants 967 patients with acute decompensated heart failure. Methods Haemoglobin and haematocrit were measured at admission and discharge and were used to calculate the plasma volume change using the Strauss-Davis-Rosenbaum formula. Main outcome measures Endpoints were death and the composite of death and/or heart failure hospitalisation. Change in plasma volume was added to ADHERE scoring to determine predictive value. Results During follow-up, 536 died and 626 died or were hospitalised with heart failure. Multivariable Cox models showed change in plasma volume was an independent predictor of mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.150 [1.031–1.283], p = 0.012) and death or heart failure hospitalisation (HR: 1.138 [1.029–1.259], p = 0.012). Kaplan–Meier analysis of change in plasma volume tertiles for outcome measures showed significant difference for the top tertile compared to the lower two. Multivariable analysis of change in plasma volume with ADHERE scoring showed change in plasma volume change remained an independent predictor of death (HR: 1.138 [1.026–1.261], p = 0.015) and death or heart failure hospitalisation (HR: 1.129 [1.025–1.243], p = 0.014). Conclusions Change in plasma volume over an admission can be used for prognostication and adds value to the ADHERE score. Change in plasma volume can be easily and inexpensively calculated from routine blood tests. Clinically, this may facilitate targeted treatment of acute decompensated heart failure patients at greatest risk.

Prognostic Value of Calculated Plasma Volume Status in Patients Admitted for Acute Decompensated Heart Failure ― A Prospective Comparative Study With Other Indices of Plasma Volume ―

“…Several studies have evaluated the prognostic value of formulas for the estimation of PV and PVS in ADHF patients. [14][15][16][17] Using data from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), Duarte et al 14 examined the prognostic value of the PV, as estimated by the Strauss, Kaplan, and Hakim formulas. They found that of these 3 formulas, the strongest association was found between the estimated PV variation calculated by the Strauss formula and poor clinical outcome.…”

Plasma Volume and Renal Function Predict Six-Month Survival after Hospitalization for Acute Decompensated Heart Failure

“…It has been shown that decreased congestion, as manifested by hemoconcentration and a decrease in absolute PV, is associated with improved mortality [4,5,6,10,23]. This decrease in PV suggests that diuresis exceeds the rate of plasma refill from the extravascular space and is maintained over the period of decongestive therapy.…”

“…PV is generally well regulated in healthy individuals by complex signaling of neuroendocrine systems that maintain water and sodium homeostasis [1]. Any imbalance in the neurohormonal cascade can precipitate detrimental increases in PV in acute decompensated heart failure (ADHF) [2], leading to symptoms of congestion [3] and increased mortality [4,5,6]. These perturbations in PV may be corrected with diuresis, and the imbalance in the neurohormonal cascade attenuated by inhibitors of the renin-angiotensin-aldosterone system (RAAS).…”

Empagliflozin's Ameliorating Effect on Plasma Triglycerides: Association with Endothelial Function Recovery in Diabetic Patients with Coronary Artery Disease

“…The change in plasma volume can be used for prognostication in acute decompensated heart failure, and whole body plasma volume loss may be one of the possible mechanisms for the beneficial effects of SGLT2 inhibitors for cardiovascular diseases 17,18) . The Strauss-Davis-Rosenbaum formula is an easily accessible marker of estimating the percentage change in plasma volume in the clinical setting.…”

“…All participants completed a 12 h overnight fast before the CMT, as previously described 17) . Briefly, the cookie was ingested with water within a 20 min period, and blood samples for PG, IRI, and TG measurement were obtained at 0, 1, and 2 h after the participant had ingested half the volume of the cookie.…”