Abdulla A Damluji1, Conrad Macon2, Arieh Fox2, Grettel Garcia2, Mohammed S Al-Damluji3, George R Marzouka2, Robert J Myerburg2, Ian C Gilchrist4, Mauricio G Cohen2, Mauro Moscucci5. 1. Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States; Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States. 2. Cardiovascular Division, University of Miami School of Medicine, Miami, FL, United States. 3. Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States. 4. Penn State Heart & Vascular Institute, Hershey, PA, United States. 5. Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD, United States. Electronic address: mmoscucc@lifebridgehealth.org.
Abstract
INTRODUCTION: The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. METHODS: We examined 433 patients enrolled in the ESCAPE trial. RESULTS: Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p=0.011), had lower systolic BP (mmHg) (99 vs. 106, p=0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p=0.025), higher BUN (mg/dL) (37 vs. 26, p<0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p<0.001) and higher hospital length of stay (10days vs. 6days, p=<0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2g/dL: 10% versus 3%, p=0.010; 3g/dL: 5% versus 0%, p=0.005). After adjustments, a drop of hemoglobin with at least 1g/dL was associated with increased mortality risk (Adjusted HR 2.38, p=0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p=0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1g/dL: 1.88, p=0.043; Hb Drop2g/dL: 3.6 p=0.025). CONCLUSION: In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.
RCT Entities:
INTRODUCTION: The effect of acute changes of hemoglobin during index heart failure admission on long-term outcomes remains unknown. METHODS: We examined 433 patients enrolled in the ESCAPE trial. RESULTS: Of the 433 patients, 324 (75%) had baseline and discharge hemoglobin available for analysis. Of those, 64 (20%) had at least 1g/dL drop of hemoglobin by time of discharge. Compared to patients without hemoglobin changes (g/dL), patients with hemoglobin drop were older (59 vs. 55, p=0.011), had lower systolic BP (mmHg) (99 vs. 106, p=0.017), lower sodium (mg/dL) (136 vs. 137 (mg/dL), p=0.025), higher BUN (mg/dL) (37 vs. 26, p<0.001), higher creatinine (mg/dL) (1.6 vs. 1.3, p<0.001) and higher hospital length of stay (10days vs. 6days, p=<0.001). Higher hemoglobin drop was observed in the pulmonary artery catheter (PACs) (vs. clinical care) randomized arm of the trial (2g/dL: 10% versus 3%, p=0.010; 3g/dL: 5% versus 0%, p=0.005). After adjustments, a drop of hemoglobin with at least 1g/dL was associated with increased mortality risk (Adjusted HR 2.38, p=0.003) and higher hemoglobin concentrations by the time of discharge was associated with lower mortality rate (Adjusted HR 0.79, p=0.003). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin. However, PACs use was an independent predictor of hemoglobin drop during heart failure admission (Adjusted OR: Hb Drop 1g/dL: 1.88, p=0.043; Hb Drop 2g/dL: 3.6 p=0.025). CONCLUSION: In-hospital decrease in hemoglobin is independently associated with increased long-term mortality and hospital length of stay in ADHF. The ideal hemoglobin levels in ADHFpatients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.
Authors: Marianne E Nellis; Marisa Tucci; Jacques Lacroix; Philip C Spinella; Kelly D Haque; Arabela Stock; Marie E Steiner; E Vincent S Faustino; Nicole D Zantek; Peter J Davis; Simon J Stanworth; Jill M Cholette; Robert I Parker; Pierre Demaret; Martin C J Kneyber; Robert T Russell; Paul A Stricker; Adam M Vogel; Ariane Willems; Cassandra D Josephson; Naomi L C Luban; Laura L Loftis; Stéphane Leteurtre; Christian F Stocker; Susan M Goobie; Oliver Karam Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598