Higher level at admission and subsequent decline in hemoglobin in patients with acute pulmonary edema.
BACKGROUND
Acute pulmonary edema (APE) often occurs without remarkable fluid retention, and the benefits of diuretics are unclear in such patients. Although aggressive diuresis induces an increase in intravascular substances including hemoglobin (Hb), acute changes in Hb level remain to be investigated.


RESULTS
We analyzed 237 consecutive acute heart failure patients (74±12 years; 60.8% men) without shock, hemodialysis, bleeding, or urgent coronary angiography. APE was defined as acute onset of dyspnea within the preceding 6h and radiographic alveolar edema requiring immediate airway intervention. At admission, Hb level was higher in APE (n=29) than non-APE patients (n=208; 13.4±2.2 vs 12.2±2.1g/dl, P<0.01). Although diuretic therapy was performed in 232 patients (97.9%), hemoconcentration (ie, any increase in Hb) was observed in only 64 patients (27.0%) at 24h after admission. Conversely, Hb level decreased in both groups and the difference was larger in APE patients (-1.8±1.1 in APE and -0.5±1.0g/dl in non-APE patients, P<0.001). APE was significantly related to a greater decrease in Hb after adjusting for baseline Hb (β=-1.08g/dl, SE=0.20, P<0.001, ANCOVA).


CONCLUSIONS
APE patients had higher Hb level at admission and a more remarkable decline in 24h than did those without APE. Acute change in Hb might be caused by factors other than diuresis-induced hemoconcentration. The present findings may be useful in the selection of diuretic strategies.
Division of Cardiology, Yokohama City University Medical Center.
Masaaki
M
Konishi
Yasushi
Y
Matsuzawa
Hiroyuki
H
Suzuki
Eiichi
E
Akiyama
Noriaki
N
Iwahashi
Nobuhiko
N
Maejima
Mitsuaki
M
Endo
Kengo
K
Tsukahara
Kiyoshi
K
Hibi
Masami
M
Kosuge
Toshiaki
T
Ebina
Kentaro
K
Sakamaki
Satoshi
S
Morita
Satoshi
S
Umemura
Kazuo
K
Kimura
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011654:Pulmonary Edema / Q000097:blood* / Q000209:etiology; D013997:Time Factors
D006454:Hemoglobins