Darawsha Wisam, Chirmicci Stefan, Solomonica Amir, Wattad Malak, Kaplan Marielle, Makhoul Badira F, Abassi Zaid A, Azzam Zaher S, Aronson Doron
Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel.
J Card Fail. 2016 Sep;22(9):680-8. doi: 10.1016/j.cardfail.2016.04.005. Epub 2016 Apr 11.
Hemoconcentration has been proposed as a surrogate for successful decongestion in acute heart failure (AHF). The aim of the present study was to evaluate the relationship between hemoconcentration and clinical measures of congestion.
We studied 704 patients with AHF and volume overload. A composite congestion score was calculated at admission and discharge, with a score >1 denoting persistent congestion. Hemoconcentration was defined as any increase in hematocrit and hemoglobin levels between baseline and discharge. Of 276 patient with hemoconcentration, 66 (23.9%) had persistent congestion. Conversely, of 428 patients without hemoconcentration, 304 (71.0%) had no clinical evidence of congestion. Mean hematocrit changes were similar with and without persistent congestion (0.18 ± 3.4% and -0.19 ± 3.6%, respectively; P = .17). There was no correlation between the decline in congestion score and the change in hematocrit (P = .93). Hemoconcentration predicted lower mortality (hazard ratio 0.70, 95% confidence interval 0.54-0.90; P = .006). Persistent congestion was associated with increased mortality independent of hemoconcentration (Ptrend = .0003 for increasing levels of congestion score).
Hemoconcentration is weakly related to congestion as assessed clinically. Persistent congestion at discharge is associated with increased mortality regardless of hemoconcentration. Hemoconcentration is associated with better outcome but cannot substitute for clinically derived estimates of congestion to determine whether decongestion has been achieved.
血液浓缩已被提议作为急性心力衰竭（AHF）中成功解除充血的替代指标。本研究的目的是评估血液浓缩与充血临床指标之间的关系。
我们研究了704例AHF和容量超负荷患者。在入院时和出院时计算综合充血评分，评分>1表示持续充血。血液浓缩定义为基线至出院期间血细胞比容和血红蛋白水平的任何升高。在276例有血液浓缩的患者中，66例（23.9%）有持续充血。相反，在428例无血液浓缩的患者中，304例（71.0%）无充血的临床证据。有持续充血和无持续充血患者的平均血细胞比容变化相似（分别为0.18±3.4%和-0.19±3.6%；P = 0.17）。充血评分的下降与血细胞比容的变化之间无相关性（P = 0.93）。血液浓缩预示较低的死亡率（风险比0.70，95%置信区间0.54 - 0.90；P = 0.006）。持续充血与死亡率增加相关，且与血液浓缩无关（充血评分升高时Ptrend = 0.0003）。
临床评估显示血液浓缩与充血的关系较弱。出院时的持续充血与死亡率增加相关，与血液浓缩无关。血液浓缩与较好的预后相关，但不能替代临床得出的充血评估来确定是否已实现充血解除。
