1. HEMOCONCENTRATION AS A PREDICTOR OF DISCHARGE HEART FAILURE
OF SURVIVAL IN THE YEAR
OF DISCHARGE HEART FAILURE
J. Grau-Amorós1, M. Montero2, F. Formiga3, A. Serrado1, A. Armengou4, A. Conde5,
O. Aramburu6, and Rica Investigators7
(1) Hospital Municipal de Badalona. Badalona (Barcelona); (2) Hospital Universitario Reina Sofía. Córdoba (Córdoba); (3) Hospital Universitari de Bellvitge. L\'Hospitalet de Llobregat (Barcelona); (4) Hospital Universitari de Girona Dr. Josep Trueta. Girona (Girona); (5) Hospital Universitario de Gran Canaria Dr. Negrín. Las Palmas de Gran Canaria (Las Palmas); (6) Hospital Universitario Virgen Macarena. Sevilla (Sevilla); (7) Grupo Insuficiencia Cardiaca. Sociedad Española de Medicina Interna.
OBJECTIVES
To determine whether the degree of hemoconcentration clinic achieved in the three months after a hospital admission for heart failure (HF) is a prognostic factor for re-admission for cardiovascular causes or death during the first year of follow-up
MATERIAL AND METHOD
Patients included in the RICA Register who have completed one year of follow-up. We excluded patients treated with iron, erythropoietin or red blood cell transfusion and patients with liver cirrhosis, nephrotic syndrome, or an estimated glomerular filtration < 30 ml/min. We defined hemoconcentration as the upper quartile of the distribution of change in the haemoglobin (Hb), expressed in %, in the third month following discharge compared with the initial admission. Statistical analysis using the SPSS program using the Student t test, Wilcoxon or the chi squared according to the category of variables in the univariate analysis, the method of Kaplan-Meier and Cox proportional hazards model to estimate the independent association between hemoconcentration and death. It is considered with statistical significance for all analysis a p < 0.05
RESULTS
542 patients, mean age 76.9 years (range = 50-96). Mean follow up to the first event of days. The group with hemoconcentration showed lower BMI (28.2 ± 5.1 vs 29.4 ± 5.8; p = ); lower value of Hb (11.2 ±1.5 vs 13.4 ± 1.6 ; p < ) and received the highest cumulative dose of loop diuretics (57.4 ± 35.2 vs 50.1 ± 29.1 ; p = 0.023). However, in the three months there were no differences in weight, glomerular filtration and Hb between both groups (table 1).
Table 1.- Changes in Clinical Parameters in the Third Month [median (SD)]
Hemoconcentration no
yes
Total P
Weigth, Kg
75.7 (15.3)
73.9 (13.7)
75.3 (15.0)
 0.317
Hemoglobin, g/dL
 12.7 (1.4)
12.9 (1.5)
12.8 (1.4)
0.152 
Serum Sodium, mEq/L
139.7 (3.1) 
139.5 (3.5)
139.6 (3.2)
 0.560
Serum Creatinine, mg/dL
1.2 (0.4) 
1.2 (0.3)
1.2 (0.4)
 0.689
GFR, mL/min
59.8 (20.3) 
60.6 (20.6)
59.9 (20.4)
 0.707
We have witnessed 134 deaths (24.7 %) and 129 readmissions because of cardiovascular causes (23.8 %) (table 2).
Table 2.- Patient Outcomes after one year [N (%)]
Hemoconcentration no
yes
Total p
Mortality
96 (23.6)
38 (28.1)
134 (24.7)
0.301
Mortality or CV readmission
173 (42.,5)
58 (43.0)
231 (42.6)
0.99
CV readmission
 100 (24.6)
29 (21.5)
129 (23.8)
0.487 
While the curve of survival of both groups is separated in the first quarter, not reaching statistical significance in the following year (Figure a). For readmission, the curves were similar throughout the first year of follow-up (Figure b).
In the univariate analysis hemoconcentration showed no significance whatsoever to mortality the following year. In the multivariate analysis, were predictors of mortality age (RR 1.05 ; 95% CI ), ischemic heart disease (RR 1.6 ; 95% CI ), BMI (RR 0.92 ; 95% CI ) and functional class III and IV of the NYHA (RR 3; 95% CI and RR 5.2 ; 95% CI ,3 respectively).
DISCUSSION
The hemoconcentration in patients with HF who have been discharged from a hospital admission has been associated with increased doses of diuretics and further deterioration of renal function. Contrary to what we would expect, this reduces the risk of death in the following year1,2. In the two published studies establishing the state of hemoconcentration at discharge after an episode of acute heart failure, at which the patients received the highest doses of loop diuretics in a short time. The first includes only patients with left ventricular ejection fraction depressed. The second also includes patients with preserved ventricular fraction, although at a single hospital. We wanted to find out if the state of hemoconcentration, seen at 3 months follow-up of a multicenter cohort of HF, also has a protective effect, with the patient stabilized and optimized drug treatment.
CONCLUSIONS
The hemoconcentration 3 months after admission HF has no character prognosis for readmission or death in the following year, nor does it imply a worsening of the glomerular filtrate.
REFERENCES
Testani JM, Chen J, McCauley BD, Kimmel SE, and Shannon RP. Potential Effects of Aggressive Decongestion During the Treatment of Descompensated Heart Failure on Renal Function and Survival. Circulation 2010; 122:
Davila C, Reyentovich A, and Katz SD. Clinical Correlates of Hemoconcentration During Hospitalization for Acute Decompensated Heart Failure. J Cardiac Fail 2011; 17:
Pérez-Calvo JI, Montero-Pérez-Barquero M, Camafort-Babkowski M, Conthe-Gutiérrez P, Formiga F, Aramburu-Bodas O et al. Influence of admission blood pressure on mortality in patients with acute decompensated heart failure. QJM. 2011; 104:325-33