[Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure].
OBJECTIVE
Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level.


METHODS
The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction <45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months.


RESULTS
Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011-1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083-3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087-1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005-1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463-5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103-1.375; P<.001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058-1.255; P<.001), but not with readmission for non-fatal HF (RR per g/dL=1.081, 95% CI, 0.962-1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40-3.41; P=.001).


CONCLUSIONS
In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics.
Redondo-Bermejo
Belén
B
Servicio de Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Pascual-Figal
Domingo A
DA
Hurtado-Martínez
José A
JA
Montserrat-Coll
Jorge
J
Peñafiel-Verdú
Pablo
P
Pastor-Pérez
Francisco
F
Giner-Caro
José A
JA
Valdés-Chávarri
Mariano
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D002303:Cardiac Output, Low / Q000097:blood* / Q000150:complications / Q000401:mortality*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000401:mortality*
D006454:Hemoglobins