The top tertile of hematocrit change during hospitalization is associated with lower risk of mortality in acute heart failure patients

Abstract

BackgroundHemoconcentration has been proposed as surrogate for changes in volume status among patients hospitalized with acute heart failure (AHF) and is associated with a favorable outcome. However, there is a dearth of research assessing the clinical outcomes of hospitalized patients with hemoconcentration, hemodilution and unchanged volume status.MethodsWe enrolled 510 consecutive patients hospitalized for AHF from April 2011 to July 2015. Hematocrit (HCT) levels were measured at admission and either at discharge or on approximately the seventh day of admission. Patients were stratified by delta HCT tertitles into hemodilution (ΔHCT ≤ − 1.6%), no change (NC, −1.6% < ΔHCT ≤1.5%) and hemoconcentration (ΔHCT >1.5%) groups. The endpoint was all-cause death, with a median follow-up duration of 18.9 months.ResultsHemoconcentration was associated with lower left ventricle ejection fraction, as compared with NC and hemodilution groups, while renal function at entry, New York Heart Association class IV, and in-hospital worsening renal function (WRF) were not significantly different across the three groups. After multivariable adjustment, hemoconcentration had a lower risk of mortality as compared with hemodilution [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.24–0.63, P < 0.001], or NC (HR 0.54, 95% CI 0.33–0.88, P = 0.015], while hemodilution and NC did not have significantly differ in mortality (HR 0.72, 95% CI 0.48–1.10, P = 0.130).ConclusionsIn patients hospitalized with AHF, an increased HCT during hospitalization is associated with a lower risk of all-cause mortality than a decreased or unchanged HCT. Furthermore, all-cause mortality does not differ significantly between patients with unchanged and decreased HCT values.

Relation between hemoconcentration status and readmission plus mortality rate among Iranian individuals with decompensated heart failure

“…On the contrary, multiple studies revealed the inverse relations. [ 9 ], 11 18 ,[ 19 20 ] Data analysis of 1180 and 1776 patients in two randomized double blinded prospective studies demonstrated that 2-month rehospitalization was less frequently observed in individuals showing HC plus good diuretic response. [ 18 ] Another study on 336 HF persons with EF â30% revealed that while HC defining as any increased level of Hb or hematocrit (Hct) or plasma protein from baseline to discharge time was associated with worsening of renal function, 6-month mortality had been significantly lower than subjects not showing HC.…”

“…Finally, they found that persons with HC had a lower likelihood of death compared to HD (HR: 0.39, 95% CI = 0.24–0.63) and NC ones (HR: 0.54, 95% CI = 0.33–0.88). [ 11 ] The other study on 2357 enrolled acute HF patients in order to calculate all-cause mortality and readmission rate suggested that obtaining HC during hospitalization period was associated with lower occurrence of adverse clinical events (HR: 0.67, 95% CI = 0.56–0.79, P < 0.001). [ 20 ] One study done over 1969 individuals referring with acute HF plus mild to moderate kidney dysfunction.…”

“…[ 9 ] Till today, diuretic therapy is one of the most usual decongested modality routinely used in health care settings, but optimum dosages leading to successful symptoms relief and decreased readmission rates required to be more investigated. [ 10 11 ] Recently, hemoconcentration (HC) was introduced as a potential biomarker indicating the balance between intravascular volume reduction and capillary refill rate. This surrogate marker has been found to have associations with prediction of hospital readmission and mortality rates among HF patients.…”

Congestive Heart Failure Exhibited Higher BMI With Lower Energy Intake and Lower Physical Activity Level: Data From the National Health and Examination Nutrition Survey

“…It was analyzed as a continuous variable for total activates MET and MET in each activity. Hematocrit (%) and hemoglobin (g/dL), which may imply hemodilution ( 15 ), were acquired from blood collected during the MEC examination using methods described by the US Department of Health and Human Services.…”

Congestive Heart Failure Exhibited Higher BMI With Lower Energy Intake and Lower Physical Activity Level: Data From the National Health and Examination Nutrition Survey

“…These results demonstrated that hemodilution and uid retention are common in CHF, especially in those with lower BMI level (BMI < 30kg/m 2 ). Previous studies indicated a higher mortality rate in patients with hemodilution than in those with hemoconcentration in acute heart failure patients [15], while uid restriction could only improve signs and symptoms of chronic heart failure in patients in moderate to severe chronic heart failure [40] and aggressive uid removal positively affected survival [41]. In the present study, CHF with BMI ≥ 30kg/m 2 participants had higher hematocrit and hemoglobin concentration than BMI < 30kg/m 2 ones, indicating that obese CHF participants were less likely to develop hemodilution.…”