title: Haemoconcentration, renal function, and post-discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial.
abstract: OBJECTIVE
  Haemoconcentration has been studied as a marker of decongestion in patients with hospitalization for heart failure (HHF). We describe the relationship between haemoconcentration, worsening renal function, post-discharge outcomes, and clinical and laboratory markers of congestion in a large multinational cohort of patients with HHF.
  
  
  RESULTS
  In 1684 patients with HHF with ejection fraction (EF) ≤40% assigned to the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, absolute in-hospital haematocrit change was calculated as the change between baseline and discharge or day 7 (whichever occurred first). Patient characteristics, changes in renal function, and outcomes over a median follow-up of 9.9 months were compared by in-hospital haematocrit change. Overall, 26% of patients had evidence of haemoconcentration (i.e., ≥3% absolute increase in haematocrit). Patients with greater increases in haematocrit tended to have better baseline renal function. Haemoconcentration correlated with greater risk of in-hospital worsening renal function, but renal parameters generally returned to baseline within 4 weeks post-discharge. Patients with haemoconcentration were less likely to have clinical congestion at discharge, and experienced greater in-hospital decreases in body weight and natriuretic peptide levels. After adjustment for baseline clinical risk factors, every 5% increase of in-hospital haematocrit change was associated with a decreased risk of all-cause death [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.70-0.95]. Haematocrit change was also associated with decreased cardiovascular mortality or heart failure (HF) hospitalization at ≤100 days post-randomization (HR 0.73, 95% CI 0.71-0.76).
  
  
  CONCLUSIONS
  In this large cohort of patients with HHF with reduced EF, haemoconcentration was associated with greater improvements in congestion and decreased mortality and HF re-hospitalization despite an increased risk of in-hospital worsening renal function.
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Haris
authors.initials: H
authors.lastname: Subacius
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006400:Hematocrit / Q000379:methods / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology; D013318:Stroke Volume; D016019:Survival Analysis; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D002317:Cardiovascular Agents; D045265:Natriuretic Peptides; D000077602:Tolvaptan
keywords: Congestion; Haematocrit; Haemoconcentration; Heart failure; Outcomes; Renal function