Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure
Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marke...
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| Veröffentlicht in: | The American journal of cardiology 2019-12, Vol.124 (11), p.1707-1711 |
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| creator | Griffin, Matthew Rao, Veena S. Fleming, James Raghavendra, Parinita Turner, Jeffrey Mahoney, Devin Wettersten, Nicholas Maisel, Alan Ivey-Miranda, Juan B. Inker, Lesley Tang, Wai Hong Wilson Wilson, Francis Perry Testani, Jeffrey M. |
| description | Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p |
| doi_str_mv | 10.1016/j.amjcard.2019.08.034 |
| format | Article |
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An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p <0.01), higher loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p <0.001) compared with the remainder of the cohort. In isolation, neither worsening creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated with improved survival. However, patients who experienced both (21%) had significantly better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine, which can be determined prospectively during patient care, was associated with in-hospital parameters consistent with aggressive diuresis and improved postdischarge survival.</description><identifier>ISSN: 0002-9149</identifier><identifier>ISSN: 1879-1913</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2019.08.034</identifier><identifier>PMID: 31601358</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Aged ; Biomarkers - blood ; Blood pressure ; Confidence intervals ; Congestive heart failure ; Creatinine ; Creatinine - blood ; Diabetes ; Diuresis ; Diuretics ; Diuretics - therapeutic use ; Female ; Heart failure ; Heart Failure - complications ; Heart Failure - drug therapy ; Heart Failure - mortality ; Hemoglobin ; Hospital Mortality - trends ; Hospitalization ; Humans ; Hypertension ; Hypotheses ; Laboratories ; Male ; Mortality ; Noise ; Patients ; Prognosis ; Retrospective Studies ; Studies ; Survival ; Survival Rate - trends ; United States - epidemiology ; Water-Electrolyte Imbalance - blood ; Water-Electrolyte Imbalance - complications ; Weight control</subject><ispartof>The American journal of cardiology, 2019-12, Vol.124 (11), p.1707-1711</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-1cdf89778b085d4ad0db3c64bad5ba57eeb270d35b89ee8ba5d52638a6331d4d3</citedby><cites>FETCH-LOGICAL-c495t-1cdf89778b085d4ad0db3c64bad5ba57eeb270d35b89ee8ba5d52638a6331d4d3</cites><orcidid>0000-0001-8800-7298 ; 0000-0002-8335-735X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2314912684?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31601358$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Griffin, Matthew</creatorcontrib><creatorcontrib>Rao, Veena S.</creatorcontrib><creatorcontrib>Fleming, James</creatorcontrib><creatorcontrib>Raghavendra, Parinita</creatorcontrib><creatorcontrib>Turner, Jeffrey</creatorcontrib><creatorcontrib>Mahoney, Devin</creatorcontrib><creatorcontrib>Wettersten, Nicholas</creatorcontrib><creatorcontrib>Maisel, Alan</creatorcontrib><creatorcontrib>Ivey-Miranda, Juan B.</creatorcontrib><creatorcontrib>Inker, Lesley</creatorcontrib><creatorcontrib>Tang, Wai Hong Wilson</creatorcontrib><creatorcontrib>Wilson, Francis Perry</creatorcontrib><creatorcontrib>Testani, Jeffrey M.</creatorcontrib><title>Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p <0.01), higher loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p <0.001) compared with the remainder of the cohort. In isolation, neither worsening creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated with improved survival. However, patients who experienced both (21%) had significantly better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine, which can be determined prospectively during patient care, was associated with in-hospital parameters consistent with aggressive diuresis and improved postdischarge survival.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Blood pressure</subject><subject>Confidence intervals</subject><subject>Congestive heart failure</subject><subject>Creatinine</subject><subject>Creatinine - blood</subject><subject>Diabetes</subject><subject>Diuresis</subject><subject>Diuretics</subject><subject>Diuretics - therapeutic use</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - mortality</subject><subject>Hemoglobin</subject><subject>Hospital Mortality - trends</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypotheses</subject><subject>Laboratories</subject><subject>Male</subject><subject>Mortality</subject><subject>Noise</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Studies</subject><subject>Survival</subject><subject>Survival Rate - 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An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p <0.01), higher loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p <0.001) compared with the remainder of the cohort. In isolation, neither worsening creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated with improved survival. However, patients who experienced both (21%) had significantly better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine, which can be determined prospectively during patient care, was associated with in-hospital parameters consistent with aggressive diuresis and improved postdischarge survival.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31601358</pmid><doi>10.1016/j.amjcard.2019.08.034</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-8800-7298</orcidid><orcidid>https://orcid.org/0000-0002-8335-735X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Aged Biomarkers - blood Blood pressure Confidence intervals Congestive heart failure Creatinine Creatinine - blood Diabetes Diuresis Diuretics Diuretics - therapeutic use Female Heart failure Heart Failure - complications Heart Failure - drug therapy Heart Failure - mortality Hemoglobin Hospital Mortality - trends Hospitalization Humans Hypertension Hypotheses Laboratories Male Mortality Noise Patients Prognosis Retrospective Studies Studies Survival Survival Rate - trends United States - epidemiology Water-Electrolyte Imbalance - blood Water-Electrolyte Imbalance - complications Weight control |
| title | Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure |
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