title: Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function.
abstract: Treatment goals in acute heart failure (AHF) are poorly defined. We aimed to characterize further the impact of in-hospital haemoconcentration and worsening renal function (WRF) on short- and long-term mortality.
  
  
  
  Haematocrit, haemoglobin, total protein, serum creatinine, and albumin levels were measured serially in 1019 prospectively enrolled AHF patients. Haemoconcentration was defined as an increase in at least three of four of the haemoconcentration-defining parameters above admission values at any time during the hospitalization. Patients were divided into early (Day 1-4) and late haemoconcentration (>Day 4). Ninety-day mortality was the primary endpoint. Haemoconcentration occurred in 392 (38.5%) patients, with a similar incidence of the early (44.6%) and late (55.4%) phenotype. Signs of decongestion (reduction in BNP blood concentrations, P = 0.003; weight loss, P = 0.002) were significantly more pronounced in haemoconcentration patients. WRF was more common in haemoconcentration patients (P = 0.04). After adjustment for established risk factors for AHF mortality, including WRF and HF therapy at discharge, haemoconcentration was significantly associated with a reduction in 90-day mortality [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37-0.95, P = 0.01]. The beneficial effect of haemoconcentration seemed to be exclusive for late haemoconcentration (late vs. early: adjusted HR 0.41, 95% CI 0.19-0.90, P = 0.03) and persisted in patients with or without WRF.
  
  
  
  Haemoconcentration represents an inexpensive and easily assessable pathophysiological signal of adequate decongestion in AHF and is associated with lower mortality. WRF in the setting of haemoconcentration does not appear to offset the benefits of haemoconcentration.
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.|Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Zoraida Moreno
authors.initials: ZM
authors.lastname: Weidmann
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Gantenbein
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.|Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Stallone
authors.affiliation: Department of Laboratory Medicine, University Hospital, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Kozhuharov
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Sabti
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Breitenbücher
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.|Department of Intensive Care, University Hospital, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Honegger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.|Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Wagener
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Carmela
authors.initials: C
authors.lastname: Schumacher
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.|Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Hillinger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000378:metabolism; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism*; D051437:Renal Insufficiency / Q000378:metabolism*; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D006454:Hemoglobins; D011506:Proteins; D012709:Serum Albumin; D003404:Creatinine
keywords: Acute heart failure; Haemoconcentration; Mortality; Worsening renal function