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

TY - JOUR

T1 - Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function

AU - Breidthardt, Tobias

AU - Weidmann, Zoraida Moreno

AU - Twerenbold, Raphael

AU - Gantenbein, Claudine

AU - Stallone, Fabio

AU - Rentsch, Katharina

AU - Rubini Gimenez, Maria

AU - Kozhuharov, Nikola

AU - Sabti, Zaid

AU - Breitenbücher, Dominik

AU - Wildi, Karin

AU - Puelacher, Christian

AU - Honegger, Ursina

AU - Wagener, Max

AU - Schumacher, Carmela

AU - Hillinger, Petra

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Publisher Copyright: © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Aims: Treatment goals in acute heart failure (AHF) are poorly defined. We aimed to characterize further the impact of in-hospital haemoconcentration and worsening renal function (WRF) on short- and long-term mortality. Methods and results: Haematocrit, haemoglobin, total protein, serum creatinine, and albumin levels were measured serially in 1019 prospectively enrolled AHF 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 BNP blood concentrations, P = 0.003; weight loss, P = 0.002) were significantly more pronounced in haemoconcentration patients. WRF was more common in haemoconcentration patients (P = 0.04). After adjustment for established risk factors for AHF mortality, including WRF and HF therapy at discharge, haemoconcentration was significantly associated with a reduction in 90-day mortality [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37–0.95, P = 0.01]. The beneficial effect of haemoconcentration seemed to be exclusive for late haemoconcentration (late vs. early: adjusted HR 0.41, 95% CI 0.19–0.90, P = 0.03) and persisted in patients with or without WRF. Conclusions: Haemoconcentration represents an inexpensive and easily assessable pathophysiological signal of adequate decongestion in AHF and is associated with lower mortality. WRF in the setting of haemoconcentration does not appear to offset the benefits of haemoconcentration.

AB - Aims: Treatment goals in acute heart failure (AHF) are poorly defined. We aimed to characterize further the impact of in-hospital haemoconcentration and worsening renal function (WRF) on short- and long-term mortality. Methods and results: Haematocrit, haemoglobin, total protein, serum creatinine, and albumin levels were measured serially in 1019 prospectively enrolled AHF 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 BNP blood concentrations, P = 0.003; weight loss, P = 0.002) were significantly more pronounced in haemoconcentration patients. WRF was more common in haemoconcentration patients (P = 0.04). After adjustment for established risk factors for AHF mortality, including WRF and HF therapy at discharge, haemoconcentration was significantly associated with a reduction in 90-day mortality [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37–0.95, P = 0.01]. The beneficial effect of haemoconcentration seemed to be exclusive for late haemoconcentration (late vs. early: adjusted HR 0.41, 95% CI 0.19–0.90, P = 0.03) and persisted in patients with or without WRF. Conclusions: Haemoconcentration represents an inexpensive and easily assessable pathophysiological signal of adequate decongestion in AHF and is associated with lower mortality. WRF in the setting of haemoconcentration does not appear to offset the benefits of haemoconcentration.

KW - Acute heart failure

KW - Haemoconcentration

KW - Mortality

KW - Worsening renal function

UR - http://www.scopus.com/inward/record.url?scp=84991573164&partnerID=8YFLogxK

U2 - 10.1002/ejhf.667

DO - 10.1002/ejhf.667

M3 - SCORING: Journal article

C2 - 27758007

AN - SCOPUS:84991573164

VL - 19

SP - 226

EP - 236

JO - EUR J HEART FAIL

JF - EUR J HEART FAIL

SN - 1388-9842

IS - 2

ER -