title: The association between in-hospital hemoglobin changes, cardiovascular events, and mortality in acute decompensated heart failure: Results from the ESCAPE trial.
abstract: BACKGROUND
  The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown.
  
  
  METHODS
  We examined 433 patients enrolled in the ESCAPE trial.
  
  
  RESULTS
  Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p=0.011), had lower systolic BP (mmHg) (99 vs. 106, p=0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p=0.025), higher BUN (mg/dL) (37 vs. 26, p<0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p<0.001) and higher hospital length of stay (10days vs. 6days, p=<0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2g/dL: 10% versus 3%, p=0.010; 3g/dL: 5% versus 0%, p=0.005). After adjustments, a drop of hemoglobin with at least 1g/dL was associated with increased mortality risk (Adjusted HR 2.38, p=0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p=0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1g/dL: 1.88, p=0.043; Hb Drop 2g/dL: 3.6 p=0.025).
  
  
  CONCLUSIONS
  In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.
authors: Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States; Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States.
authors: Abdulla A
authors: AA
authors: Damluji
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: Conrad
authors: C
authors: Macon
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: Arieh
authors: A
authors: Fox
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: Grettel
authors: G
authors: Garcia
authors: Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States.
authors: Mohammed S
authors: MS
authors: Al-Damluji
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: George R
authors: GR
authors: Marzouka
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: Robert J
authors: RJ
authors: Myerburg
authors: Penn State Heart & Vascular Institute, Hershey, PA, United States.
authors: Ian C
authors: IC
authors: Gilchrist
authors: Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States.
authors: Mauricio G
authors: MG
authors: Cohen
authors: Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States. Electronic address: mmoscucc@lifebridgehealth.org.
authors: Mauro
authors: M
authors: Moscucci
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000401:mortality* / Q000639:trends*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Anemia; Heart failure; Hemoglobin; Hospitalization; Mortality; Prognosis