Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort

Chouihed, Tahar; Rossignol, Patrick; Bassand, Adrien; Duarte, Kévin; Kobayashi, Masatake; Jaeger, Déborah; Sadoune, Sonia; Buessler, Aurélien; Nace, Lionel; Giacomin, Gaetan; Hutter, Thibaut; Barbé, Françoise; Salignac, Sylvain; Jay, Nicolas; Zannad, Faı̈ez; Girerd, Nicolas

doi:10.1007/s00392-018-1388-y

Cited by 40 publications

(52 citation statements)

References 41 publications

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“…The hypokalemia rates found in the present study were higher than in other reports [20,21,[34][35][36]. For external validity purposes, we compared our prevalence results with another ED French cohort-the PARADISE cohort "Pathway of dyspneic patients in Emergency", consisting of including all patients over one year aged 18 years or older admitted to the ED of the Nancy University Hospital (France) for dyspnea., as previously reported by our group [37].…”

Section: Plos Onesupporting

confidence: 87%

Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department

et al. 2020

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Background Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. Aims This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. Methods Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete selfmedication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. Results A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L

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Section: Plos Onesupporting

confidence: 87%

Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department

et al. 2020

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“…Similarly, it has been recently reported that plasma volume status, calculated by means of Duarte's formula, correlates with adverse prognosis in patients with AHF [5,[17][18][19]. All of these parameters seemed to be independent predictors of poor prognosis in HF patients, independent of BNP values [5,10,12,13,18].…”

Section: Introductionmentioning

confidence: 60%

“…Although Duarte's formula overestimates plasma volume as the measurements derived from the dilution technique [25], it correlates with adverse prognosis in HF patients. In the PARADISE cohort, a threshold of 5.12 dL/g was significantly associated with a high risk of in-hospital mortality in AHF patients [17]. In a post hoc analysis of the EPHESUS trial, ePVS predicted death or readmission for HF during a follow-up period of 1-3 months [5].…”

Section: Discussionmentioning

confidence: 97%

Multiparametric approach to congestion for predicting long-term survival in heart failure

Massari¹,

Scicchitano

Iacoviello

et al. 2020

Journal of Cardiology

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Background: Congestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood urea nitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. Methods: We analyzed the data from 436 patients with acute or chronic heart failure (AHF, n = 184, and CHF, n = 252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. Results: Ninety-two patients died after a median follow-up of 463 days (IQR: 287-669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p < 0.0001). The optimal cutoffs for death occurrence were BNP: >441 pg/mL, ePVS: >5.3 dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R 2 adjusted = 0.40). Patients with all four parameters below or above their optimal cutoff had mortality rates of 4% and 59%, respectively. Conclusions: BNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.

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“…The ePVS was calculated from the Strauss-derived Duarte formula using hematocrit and hemoglobin values at admission as follows 17,27,28 and expressed in dL/g 29 :…”

Section: Estimated Plasma Volume (Epvs) Statusmentioning

confidence: 99%

Chest X-ray quantification of admission lung congestion as a prognostic factor in patients admitted for worsening heart failure from the ICALOR cohort study

Kobayashi

Bercker

Huttin

et al. 2020

International Journal of Cardiology

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Introduction: Chest X-ray (CXR) widely used, but the prognostic value of congestion quantification using CXR remains uncertain. The main objective of the present study was to assess whether initial quantification of lung congestion evaluated by CXR [and its interplay with estimated plasma volume status (ePVS)] in patients with worsening heart failure (WHF) is associated with in-hospital and shortterm clinical outcome. Methods: We studied 117 patients hospitalized for WHF in the ICALOR HF disease management program. Pulmonary congestion was estimated using congestion score index (CSI, range 0 to 3) evaluated from 6 lung areas on CXR. Systemic congestion was assessed by ePVS. Logistic regression analysis was used to assess length of stay and the composite of all-cause death or HF re-hospitalization at 90 days. Results: Patients were divided according to the median of admission CSI (median=2.20) and ePVS (median=5.38). Higher CSI was significantly associated with higher pulmonary arterial systolic pressure in multivariable models. Multivariable models showed patients with high CSI/high ePVS had a 6-day longer length of stay [OR (95%CI)=6.78 (1.82-29.79), p<0.01] and 5-fold higher risk of 90day composite outcome [OR (95%CI)=5.13 (1.26-25.11) p=0.03] compared to patients with low CSI/low ePVS, while other configurations (either isolated high CSI or high ePVS) yielded neutral associations. Furthermore, CSI and ePVS significantly improved reclassification on top of clinical covariates for the composite outcome [Net reclassification index=37.3% (0.52-87.0), p=0.046]. Conclusion: An admission assessment of pulmonary and systemic congestion in WHF patients using CSI and ePVS can identify a cluster of high-risk patients at short-term outcomes.

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Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort

Cited by 40 publications

References 41 publications

Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department

Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department

Multiparametric approach to congestion for predicting long-term survival in heart failure

Chest X-ray quantification of admission lung congestion as a prognostic factor in patients admitted for worsening heart failure from the ICALOR cohort study

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