Tahar Chouihed1,2,3,4, Patrick Rossignol2,3,4, Adrien Bassand1,2,3, Kévin Duarte2,3,5,6,7, Masatake Kobayashi2,3,8, Déborah Jaeger1,2,3, Sonia Sadoune1, Aurélien Buessler1, Lionel Nace9, Gaetan Giacomin1, Thibaut Hutter1, Françoise Barbé10, Sylvain Salignac11, Nicolas Jay12,13, Faiez Zannad2,3,4,14, Nicolas Girerd15,16,17,18. 1. Emergency Department, University Hospital of Nancy, Vandoeuvre les Nancy, France. 2. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre les Nancy, France. 3. Groupe choc, Faculté de Médecine, INSERM U1116, 54500, Vandoeuvre les Nancy, France. 4. F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. 5. Université de Lorraine, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France. 6. Centre National de la Recherche Scientifique, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France. 7. INRIA, Project-Team BIGS, Villers-lès-Nancy, France. 8. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 9. Réanimation Médicale, Hôpital Central, CHRU Nancy, Vandoeuvre les Nancy, France. 10. Biochimie, Biologie moléculaire, Nutrition, Métabolisme, Hôpital de Brabois, CHRU Nancy, Nancy, France. 11. Hématologie, Hôpital de Brabois, CHRU Nancy, Vandoeuvre les Nancy, France. 12. Department of Medical Informatics, University Hospital, Vandoeuvre les Nancy, France. 13. Orpailleur, LORIA UMR 7503, Vandoeuvre les Nancy, France. 14. Pôle de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, CHRU Nancy, Vandoeuvre les Nancy, France. 15. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre les Nancy, France. nicolas_girerd@yahoo.com. 16. Groupe choc, Faculté de Médecine, INSERM U1116, 54500, Vandoeuvre les Nancy, France. nicolas_girerd@yahoo.com. 17. F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. nicolas_girerd@yahoo.com. 18. Pôle de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, CHRU Nancy, Vandoeuvre les Nancy, France. nicolas_girerd@yahoo.com.
Abstract
BACKGROUND: Systemic congestion, evaluated by estimated plasma volume status (ePVS), is associated with in-hospital mortality in acute heart failure (AHF). However, the diagnostic and prognostic value of ePVS in patients with acute dyspnea has been insufficiently studied. OBJECTIVES: To assess the association between the first ePVS calculated from blood samples on admission in the emergency department (ED) and discharge diagnosis of AHF and in-hospital mortality in patients admitted for acute dyspnea. METHODS: The study included 1369 patients admitted for dyspnea in the ED in 2015. ePVS was calculated from hematocrit and hemoglobin values at admission. Comparisons of baseline characteristics according to ePVS tertiles were carried out and then associations between ePVS and the two outcomes "AHF diagnosis" and "intra-hospital mortality" were assessed using a logistic regression model. RESULTS: 36.6% had a BNP > 400 pg/mL and median ePVS was 4.58 dL/g [3.96-5.55]. Overall in-hospital mortality was 11.1% (n = 149). In multivariable analysis, the third ePVS tertile (> 5.12 dL/g) had a significantly increased risk of having AHF (OR = 1.64 [1.16-2.33], p = 0.005). In-hospital mortality rose across ePVS tertiles (8.4-13.8% p < 0.01). ePVS greater than the first or second tertile threshold (respectively, 4.17 dL/g and 5.12 dL/g) were both significantly associated with a higher risk of in-hospital mortality (OR for 2nd/3rd tertile = 2.06 [1.25-3.38], p = 0.004 and OR for 3rd tertile = 1.54 [1.01-2.36], p = 0.04). CONCLUSION: Higher ePVS values determined from first blood sample at admission are associated with a higher probability of AHF and in-hospital mortality in patients admitted in the ED for acute dyspnea.
BACKGROUND: Systemic congestion, evaluated by estimated plasma volume status (ePVS), is associated with in-hospital mortality in acute heart failure (AHF). However, the diagnostic and prognostic value of ePVS in patients with acute dyspnea has been insufficiently studied. OBJECTIVES: To assess the association between the first ePVS calculated from blood samples on admission in the emergency department (ED) and discharge diagnosis of AHF and in-hospital mortality in patients admitted for acute dyspnea. METHODS: The study included 1369 patients admitted for dyspnea in the ED in 2015. ePVS was calculated from hematocrit and hemoglobin values at admission. Comparisons of baseline characteristics according to ePVS tertiles were carried out and then associations between ePVS and the two outcomes "AHF diagnosis" and "intra-hospital mortality" were assessed using a logistic regression model. RESULTS: 36.6% had a BNP > 400 pg/mL and median ePVS was 4.58 dL/g [3.96-5.55]. Overall in-hospital mortality was 11.1% (n = 149). In multivariable analysis, the third ePVS tertile (> 5.12 dL/g) had a significantly increased risk of having AHF (OR = 1.64 [1.16-2.33], p = 0.005). In-hospital mortality rose across ePVS tertiles (8.4-13.8% p < 0.01). ePVS greater than the first or second tertile threshold (respectively, 4.17 dL/g and 5.12 dL/g) were both significantly associated with a higher risk of in-hospital mortality (OR for 2nd/3rd tertile = 2.06 [1.25-3.38], p = 0.004 and OR for 3rd tertile = 1.54 [1.01-2.36], p = 0.04). CONCLUSION: Higher ePVS values determined from first blood sample at admission are associated with a higher probability of AHF and in-hospital mortality in patients admitted in the ED for acute dyspnea.
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