A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

Abstract

Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED).Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit.Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89).Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.

Correlation between Remote Dielectric Sensing and Chest X-Ray to Assess Pulmonary Congestion

“…The severity of the radiographic pulmonary congestion was evaluated using a previously reported CSI ( Figure 2 ) [ 3 , 4 , 5 ]. The scoring of the congestion was performed on each 6-segment of lung fields.…”

“…Recently, congestion score index (CSI), which is a semi-quantitative approach to evaluate pulmonary congestion based on a 6-segment evaluation of CXR, scoring each zone from 0 (no congestion) to 3 (intense alveolar pulmonary edema), has been proposed to overcome the above challenges. Several studies have demonstrated its utility for assessing pulmonary congestion [ 3 , 4 , 5 ].…”

Association Between Remote Dielectric Sensing and Body Mass Index

“…The details of measuring the congestion score index (CSI) are available in previous reports. 7,8) The degrees of congestion were assessed at a total of 6 component: upper, middle, and lower lungs in the both sides. The score was rated on a 4-point scale, from 0 for normal to 3 for confluent intense edema.…”

Effect of estimated plasma volume status and left atrial diameter on prognosis of patients with acute heart failure

“…Plasma volume (PV) was a marker of volume overload based on the Duarte formula estimated on the basis of erythrocyte volume and hemoglobin ( 5 ). Estimated PV status (ePVs) was the use of hematocrit and hemoglobin from Strauss derivative Duarte calculated in the formula, specific as shown below: ePVs (mL/g) = 100 × (1–hematocrit)/hemoglobin (g/dL) ( 6 ).…”