Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate
for plasma volume reduction and is associated with improved survival, but most definitions
only allow for hemoconcentration to be determined retrospectively. An increase in
serum creatinine can also be a marker of aggressive decongestion, but in isolation
is not specific. Our objective was to determine if combined hemoconcentration and
worsening creatinine could better identify patients that were aggressively treated
and, as such, may have improved postdischarge outcomes. A total of 4,181 patients
hospitalized with acute decompensated heart failure were evaluated. Those who experienced
both hemoconcentration and worsening creatinine at any point had a profile consistent
with aggressive in-hospital treatment and longer length of stay (p <0.01), higher
loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p
<0.001) compared with the remainder of the cohort. In isolation, neither worsening
creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated
with improved survival. However, patients who experienced both (21%) had significantly
better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine,
which can be determined prospectively during patient care, was associated with in-hospital
parameters consistent with aggressive diuresis and improved postdischarge survival.
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Article info
Publication history
Published online: September 06, 2019
Received in revised form:
August 21,
2019
Received:
June 28,
2019
Footnotes
This work was supported by National Institutes of Health, Bethesda, MD, grants, K23HL114868, L30HL115790, R01HL139629, R21HL143092, R01HL128973 (JMT), K23DK097201 (FPW), and 5T32HL007950 (MG).
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© 2019 Elsevier Inc. All rights reserved.
