Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort
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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.
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.
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.
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).
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.
KeywordsCongestion Estimated plasma volume status Acute dyspnea Emergency Acute heart failure Mortality
Acute heart failure
Brain natriuretic peptide
Estimated glomerular filtration rate
Estimated plasma volume status
We thank Pierre Pothier for editing the manuscript. TC, KD, PR, FZ and NG are supported by the French National Research Agency Fighting Heart Failure (ANR-15-RHU-0004) and GEENAGE Lorraine Université d’Excellence programs and by Contrat de Plan État Région Lorraine and FEDER IT2MP. We also thank Frederic Arnoux for biological data extraction.
Compliance with ethical standards
Conflict of interest
Dr Chouihed and Dr. Girerd have received board membership fees from Novartis. Dr. Rossignol received fees from Relypsa. Dr. Zannad has received fees for serving on the board of Boston Scientific; consulting fees from Novartis, Takeda, AstraZeneca, Boehringer Ingelheim, GE Healthcare, Relypsa, Servier, Boston Scientific, Bayer, Johnson and Johnson, and Resmed; and speakers’ fees from Pfizer and AstraZeneca. He and Dr. Rossignol are cofounders of CardioRenal diagnosticS.
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