Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Am J Med. 2014 Dec;127(12):1154-9. doi: 10.1016/j.amjmed.2014.06.009. Epub 2014 Jun 14.
One quarter of patients hospitalized for heart failure are readmitted within 30 days, perhaps related to ineffective decongestion. Limited data exist guiding the extent and duration of diuresis in patients hospitalized for heart failure. The objective of this review was to determine the prognostic value of hemoconcentration, or the relative increase in the cellular elements in blood, in patients hospitalized for heart failure and to clarify its role in guiding inpatient diuretic practices. Six post hoc retrospective studies from 2010 to 2013 were available for review. Hemoconcentration was consistently associated with markers of aggressive fluid removal, including higher diuretic dosing and reduced body weight, but increased risk of in-hospital worsening renal function. Despite this, hemoconcentration was associated with improved short-term mortality and rehospitalization. Hemoconcentration is a practical, readily available, noninvasive, economically feasible strategy to help guide diuresis and monitor congestion relief in patients hospitalized for worsening heart failure. Clinicians should strongly consider using changes in hemoglobin and hematocrit as an adjunct to other available measures of decongestion and clinical acumen in inpatient heart failure care.
四分之一因心力衰竭住院的患者在 30 天内再次入院，这可能与利尿效果不佳有关。目前仅有有限的数据可以指导心力衰竭住院患者利尿的程度和持续时间。本综述的目的是确定血液浓缩（即血液中细胞成分的相对增加）在心力衰竭住院患者中的预后价值，并阐明其在指导住院期间利尿治疗中的作用。共有 6 项 2010 年至 2013 年的回顾性事后研究可供审查。血液浓缩与积极的液体清除标志物一致，包括更高的利尿剂剂量和体重减轻，但增加了住院期间肾功能恶化的风险。尽管如此，血液浓缩与短期死亡率和再住院率的降低有关。血液浓缩是一种实用、易于获得、非侵入性、经济可行的策略，可帮助指导利尿并监测心力衰竭恶化患者的充血缓解情况。临床医生应强烈考虑将血红蛋白和红细胞压积的变化作为其他可用的充血消退措施和心力衰竭住院患者临床诊疗能力的辅助手段。
