Hudson Sarah R, Chan Daniel, Ng Leong L
Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, UK
J R Soc Med. 2016 Sep;109(9):337-46. doi: 10.1177/0141076816661316.
This study aimed to develop an inexpensive, readily available prognostic indicator in acute decompensated heart failure patients to guide management and improve outcome. Prognostic biomarkers for heart failure exist but are expensive and not routinely performed. Increasing plasma volume has been associated with worse outcomes.
UK University Teaching Hospital.
Observational Cohort study.
967 patients with acute decompensated heart failure.
Haemoglobin and haematocrit were measured at admission and discharge and were used to calculate the plasma volume change using the Strauss-Davis-Rosenbaum formula.
Endpoints were death and the composite of death and/or heart failure hospitalisation. Change in plasma volume was added to ADHERE scoring to determine predictive value.
During follow-up, 536 died and 626 died or were hospitalised with heart failure. Multivariable Cox models showed change in plasma volume was an independent predictor of mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.150 [1.031-1.283], p = 0.012) and death or heart failure hospitalisation (HR: 1.138 [1.029-1.259], p = 0.012). Kaplan-Meier analysis of change in plasma volume tertiles for outcome measures showed significant difference for the top tertile compared to the lower two. Multivariable analysis of change in plasma volume with ADHERE scoring showed change in plasma volume change remained an independent predictor of death (HR: 1.138 [1.026-1.261], p = 0.015) and death or heart failure hospitalisation (HR: 1.129 [1.025-1.243], p = 0.014).
Change in plasma volume over an admission can be used for prognostication and adds value to the ADHERE score. Change in plasma volume can be easily and inexpensively calculated from routine blood tests. Clinically, this may facilitate targeted treatment of acute decompensated heart failure patients at greatest risk.
本研究旨在为急性失代偿性心力衰竭患者开发一种廉价、易于获得的预后指标，以指导治疗并改善预后。心力衰竭的预后生物标志物虽已存在，但价格昂贵且并非常规检测项目。血浆量增加与更差的预后相关。
英国大学教学医院。
观察性队列研究。
967例急性失代偿性心力衰竭患者。
在入院时和出院时测量血红蛋白和血细胞比容，并使用施特劳斯 - 戴维斯 - 罗森鲍姆公式计算血浆量变化。
终点为死亡以及死亡和/或心力衰竭住院的复合情况。将血浆量变化添加到ADHERE评分中以确定预测价值。
在随访期间，536例患者死亡，626例患者死亡或因心力衰竭住院。多变量Cox模型显示，血浆量变化是死亡率的独立预测因素（风险比（HR）[95%置信区间（CI）]：1.150 [1.031 - 1.283]，p = 0.012）以及死亡或心力衰竭住院的独立预测因素（HR：1.138 [1.029 - 1.259]，p = 0.012）。对结局指标按血浆量变化三分位数进行的Kaplan - Meier分析显示，最高三分位数与较低的两个三分位数相比存在显著差异。对血浆量变化与ADHERE评分进行多变量分析显示，血浆量变化仍然是死亡（HR：1.138 [1.026 - 1.261]，p = 0.015）以及死亡或心力衰竭住院（HR：1.129 [1.025 - 1.243]，p = 0.014）的独立预测因素。
入院期间的血浆量变化可用于预后评估，并为ADHERE评分增加价值。血浆量变化可通过常规血液检测轻松且廉价地计算得出。临床上，这可能有助于对风险最高的急性失代偿性心力衰竭患者进行针对性治疗。
