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Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort

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Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

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Abbreviations

AHF:

Acute heart failure

BNP:

Brain natriuretic peptide

CI:

Confidence interval

ED:

Emergency department

eGFR:

Estimated glomerular filtration rate

ePVS:

Estimated plasma volume status

HF:

Heart failure

Ht:

Hematocrit

Hb:

Hemoglobin

OR:

Odds ratios

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Emergency Department, University Hospital of Nancy, Vandoeuvre les Nancy, France

    Tahar Chouihed, Adrien Bassand, Déborah Jaeger, Sonia Sadoune, Aurélien Buessler, Gaetan Giacomin & Thibaut Hutter

  2. INSERM, Centre d’Investigations Cliniques Plurithématique 1433, Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre les Nancy, France

    Tahar Chouihed, Patrick Rossignol, Adrien Bassand, Kévin Duarte, Masatake Kobayashi, Déborah Jaeger, Faiez Zannad & Nicolas Girerd

  3. Groupe choc, Faculté de Médecine, INSERM U1116, 54500, Vandoeuvre les Nancy, France

    Tahar Chouihed, Patrick Rossignol, Adrien Bassand, Kévin Duarte, Masatake Kobayashi, Déborah Jaeger, Faiez Zannad & Nicolas Girerd

  4. Department of Cardiology, Tokyo Medical University, Tokyo, Japan

    Masatake Kobayashi

  5. F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France

    Tahar Chouihed, Patrick Rossignol, Faiez Zannad & Nicolas Girerd

  6. Université de Lorraine, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France

    Kévin Duarte

  7. Centre National de la Recherche Scientifique, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France

    Kévin Duarte

  8. INRIA, Project-Team BIGS, Villers-lès-Nancy, France

    Kévin Duarte

  9. Réanimation Médicale, Hôpital Central, CHRU Nancy, Vandoeuvre les Nancy, France

    Lionel Nace

  10. Biochimie, Biologie moléculaire, Nutrition, Métabolisme, Hôpital de Brabois, CHRU Nancy, Nancy, France

    Françoise Barbé

  11. Hématologie, Hôpital de Brabois, CHRU Nancy, Vandoeuvre les Nancy, France

    Sylvain Salignac

  12. Department of Medical Informatics, University Hospital, Vandoeuvre les Nancy, France

    Nicolas Jay

  13. Orpailleur, LORIA UMR 7503, Vandoeuvre les Nancy, France

    Nicolas Jay

  14. Pôle de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, CHRU Nancy, Vandoeuvre les Nancy, France

    Faiez Zannad & Nicolas Girerd

Authors
  1. Tahar Chouihed
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  2. Patrick Rossignol
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  3. Adrien Bassand
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  14. Nicolas Jay
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  16. Nicolas Girerd
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Corresponding author

Correspondence to Nicolas Girerd.

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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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Chouihed, T., Rossignol, P., Bassand, A. et al. Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort. Clin Res Cardiol 108, 563–573 (2019). https://doi.org/10.1007/s00392-018-1388-y

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