title: Discordance Between Hemoconcentration and Clinical Assessment of Decongestion in Acute Heart Failure.
abstract: BACKGROUND
  Hemoconcentration has been proposed as a surrogate for successful decongestion in acute heart failure (AHF). The aim of the present study was to evaluate the relationship between hemoconcentration and clinical measures of congestion.
  
  
  RESULTS
  We studied 704 patients with AHF and volume overload. A composite congestion score was calculated at admission and discharge, with a score >1 denoting persistent congestion. Hemoconcentration was defined as any increase in hematocrit and hemoglobin levels between baseline and discharge. Of 276 patient with hemoconcentration, 66 (23.9%) had persistent congestion. Conversely, of 428 patients without hemoconcentration, 304 (71.0%) had no clinical evidence of congestion. Mean hematocrit changes were similar with and without persistent congestion (0.18 ± 3.4% and -0.19 ± 3.6%, respectively; P = .17). There was no correlation between the decline in congestion score and the change in hematocrit (P = .93). Hemoconcentration predicted lower mortality (hazard ratio 0.70, 95% confidence interval 0.54-0.90; P = .006). Persistent congestion was associated with increased mortality independent of hemoconcentration (Ptrend = .0003 for increasing levels of congestion score).
  
  
  CONCLUSIONS
  Hemoconcentration is weakly related to congestion as assessed clinically. Persistent congestion at discharge is associated with increased mortality regardless of hemoconcentration. Hemoconcentration is associated with better outcome but cannot substitute for clinically derived estimates of congestion to determine whether decongestion has been achieved.
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Wisam
authors.initials: W
authors.lastname: Darawsha
authors.affiliation: Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel.
authors.forename: Stefan
authors.initials: S
authors.lastname: Chirmicci
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Solomonica
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Malak
authors.initials: M
authors.lastname: Wattad
authors.affiliation: Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel.
authors.forename: Marielle
authors.initials: M
authors.lastname: Kaplan
authors.affiliation: Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel.
authors.forename: Badira F
authors.initials: BF
authors.lastname: Makhoul
authors.affiliation: Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Zaid A
authors.initials: ZA
authors.lastname: Abassi
authors.affiliation: Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel.
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel. Electronic address: daronson@tx.technion.ac.il.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D015331:Cohort Studies; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D006400:Hematocrit; D006454:Hemoglobins; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D051437:Renal Insufficiency / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D004232:Diuretics; D006454:Hemoglobins
keywords: Congestion; heart failure; hematocrit; hemoconcentration; outcomes