title: [Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure].
abstract: 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.
authors.affiliation: Servicio de Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Redondo-Bermejo
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: José A
authors.initials: JA
authors.lastname: Hurtado-Martínez
authors.forename: Jorge
authors.initials: J
authors.lastname: Montserrat-Coll
authors.forename: Pablo
authors.initials: P
authors.lastname: Peñafiel-Verdú
authors.forename: Francisco
authors.initials: F
authors.lastname: Pastor-Pérez
authors.forename: José A
authors.initials: JA
authors.lastname: Giner-Caro
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés-Chávarri
mesh_terms: 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*
chemical_list: D006454:Hemoglobins