Change in plasma volume and prognosis in acute decompensated heart failure: an observational cohort study.
OBJECTIVE
This study aimed to develop an inexpensive, readily available prognostic indicator in acute decompensated heart failure patients to guide management and improve outcome. Prognostic biomarkers for heart failure exist but are expensive and not routinely performed. Increasing plasma volume has been associated with worse outcomes.


METHODS
UK University Teaching Hospital.


METHODS
Observational Cohort study.


METHODS
967 patients with acute decompensated heart failure.


METHODS
Haemoglobin and haematocrit were measured at admission and discharge and were used to calculate the plasma volume change using the Strauss-Davis-Rosenbaum formula.


METHODS
Endpoints were death and the composite of death and/or heart failure hospitalisation. Change in plasma volume was added to ADHERE scoring to determine predictive value.


RESULTS
During follow-up, 536 died and 626 died or were hospitalised with heart failure. Multivariable Cox models showed change in plasma volume was an independent predictor of mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.150 [1.031-1.283], p = 0.012) and death or heart failure hospitalisation (HR: 1.138 [1.029-1.259], p = 0.012). Kaplan-Meier analysis of change in plasma volume tertiles for outcome measures showed significant difference for the top tertile compared to the lower two. Multivariable analysis of change in plasma volume with ADHERE scoring showed change in plasma volume change remained an independent predictor of death (HR: 1.138 [1.026-1.261], p = 0.015) and death or heart failure hospitalisation (HR: 1.129 [1.025-1.243], p = 0.014).


CONCLUSIONS
Change in plasma volume over an admission can be used for prognostication and adds value to the ADHERE score. Change in plasma volume can be easily and inexpensively calculated from routine blood tests. Clinically, this may facilitate targeted treatment of acute decompensated heart failure patients at greatest risk.
Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, UK.
Sarah R
SR
Hudson
Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, UK.
Daniel
D
Chan
Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, UK lln1@le.ac.uk.
Leong L
LL
Ng
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D008297:Male; D055641:Mathematical Concepts; D008875:Middle Aged; D010953:Plasma Volume; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk
D015415:Biomarkers; D006454:Hemoglobins
Plasma volume; acute heart failure; haematocrit; haemoglobin