Hemodilution after Initial Treatment in Patients with Acute Decompensated Heart Failure

Abstract

Decongestion is an important goal of heart failure (HF) management. Blood cell concentration is a recognized indicator for guiding decongestive treatment for HF. We aimed to assess the clinical impact of hemodilution and hemoconcentration after initial treatment in acute decompensated HF (ADHF) patients. We retrospectively evaluated hemoglobin levels and body weight obtained before admission, on admission, 3 days after admission, and at discharge in 102 consecutive patients admitted with ADHF. Patients were then stratified into hemodilution (n = 55) and hemoconcentration (n = 47) groups based on whether their hemoglobin levels decreased or increased, respectively, during the first 3 days after admission. From before admission to admission, hemoglobin levels decreased less in the hemodilution group (-0.16 ± 0.98 g/dL) than in the hemoconcentration group (-0.88 ± 1.11 g/dL) (P < 0.001); however, there was no significant difference in body weight (P≥ 0.05). More patients in the hemodilution group (85%) had grade III/IV pulmonary edema (Turner's criteria) compared with the hemoconcentration group (63%) (P < 0.01). Rate of readmission for HF within 180 days of discharge was higher in the hemodilution group (34%) compared with the hemoconcentration group (9%) (P < 0.01). Hemodilution after initial treatment for ADHF was associated with severe pulmonary edema at admission and higher readmission rates.

Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment

“…In patients with acute heart failure, haemoconcentration has been associated with clinical signs and symptoms of more aggressive decongestion and improved outcomes, including a lower risk of readmission to hospital for heart fail ure [46][47][48][49] . In one study, patients with haemodilution after initial treatment for acute heart failure had more alve olar oedema and higher body mass at baseline than patients who had haemoconcentration, which indicates translocation of fluid from the tissues to the intravascu lar space 50 . On the basis of these associations, we con clude that haemoconcentration is a sign of intravascular volume status.…”

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

“…In a study including 102 patients hospitalized for acute HF, hemodilution during the first 3 days was associated with a severe degree of pulmonary edema compared to those who had hemoconcentration (85 vs. 63%, p < 0.01). Additionally, HF-related readmission rate was higher in the hemodilution group (34 vs. 9%, p < 0.01) [43]. Likewise, in the post hoc analysis of the PROTECT trial [44], a rapid increase in hemoglobin level during the first week was independently associated with a favorable outcome, de-spite a slight decline in renal function in patients hospitalized with HF.…”

The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department

“…28 In turn, congestion is related to haemodilution which acts as a physiopathological mechanism of anaemia, that is, likewise, related to greater mortality and readmission. 29,30 Another variable which might carry a worse prognosis in the CRASþ group is a greater number of cases with SBP 100 mm Hg. This worsens RD which is already accompanied by altered renal perfusion and probably reflects worse RF in these patients with a greater elevation of serum creatinine values.…”