Hematocrit change as a predictor of readmission for decompensated heart failure: a retrospective single centre study

Abstract

In patients with acute heart failure (AHF), hemoconcentration has been suggested as a surrogate for volume changes (AHF). However, literatures comparing the outcome of AHF patients that achieved hemoconcentration during hospitalization with those that do not are limited. The aim of this research is to see if achieving hemoconcentration prior to discharge is linked to a lower risk of re-admission in AHF patients. 124 patients hospitalized in the Cardiology Unit, University Malaya Medical Centre (UMMC) for AHF between November 2019 and November 2020 were enrolled. Information on patients' clinical characteristics, laboratory values and in-hospital treatments were collected through electronic medical record. At admission and discharge, the change in hematocrit (HCT) levels was calculated, and patients were stratified based on two quantiles of delta HCT, either discharged with hemoconcentration (∆HCT >1.5%) or without hemoconcentration (∆HCT ≤1.5%). The study's outcome was AHF readmission after a 90-day follow-up period. Readmission was significantly associated with ejection fraction (p = 0.032) and HCT change (p = 0.005). Consecutively, logistic regression performed revealed that patients with haemoconcentration were 78.3% less likely to be readmitted than those without haemoconcentration (OR = 0.217, p = 0.003, 95% CI = 0.078-0.605) and Patients with a lower ejection fraction have a threefold greater chance of being readmitted than those with a preserved ejection fraction (OR = 3.316, p = 0.022, 95% CI = 1.188-9.256). In conclusion, among patients hospitalized and discharged for AHF, those that (i) do not achieve haemoconcentration and (ii) patients with a reduced ejection fraction were more likely to be readmitted with acute heart failure. Therefore, optimising patients' haematocrit levels prior to discharge may potentially reduce rehospitalizations among heart failure patients.

Factors associated with in-hospital mortality in adult sepsis with Escherichia coli infection

“…Another study in Brazil found that as a predictor of mortality risk in the sepsis, the level of HCT decreased with worse outcomes [ 21 ]. However, a positive relationship between HCT and mortality was found in our study, which was not consistent with some previous studies [ 22 , 23 ]. The differences could be partly explained by two reasons.…”

The combined impact of hyponatremia and hematocrit on the risk for 90-day readmission and death in patients with heart failure: dilutional hyponatremia versus depletional hyponatremia

“… 26 Studies have shown that optimizing hematocrit levels before discharge contributes to reducing rehospitalization and improving survival in HF patients. 27 , 28 Therefore, we used the optimal cut-off point of hematocrit (35%) to distinguish DiH and DeH as prior studies did. Our analysis revealed that only DiH, but not DeH, was independently associated with short-term outcomes, which is consistent with previous studies.…”

Comparison of the red blood cell indices based on accuracy, sensitivity, and specificity to predict one-year mortality in heart failure patients

“…Compensatory mechanisms to evade tissue hypoxia include an increase in cardiac output by sympathetic stimulation, redistribution of blood flow, an increase in whole-body oxygen extraction ratio, and activation of aortic chemoreceptors with an increase in venomotor tone [ 18 ]. Achievement of hemoconcentration in hospitalized AHF patients showed to have better survival, compared to hemodilution [ 19 ]. Ling et al [ 20 ] showed that plasma volume, which depends on weight and HCT, was a predictor for prognosis in heart failure patients so HCT was also associated with prognosis in heart failure patients.…”