Abstract 13858: Early Hemoglobin Decrease in Heart Failure With Acute Pulmonary Edema
Background: Diuretic therapy, which is a mainstay of acute heart failure syndrome (AHFS) treatment, is also reported to be associated with harmful effect. In particular, acute pulmonary edema (APE) often causes without remarkable fluid retention, and the benefits of diuretic therapy are unclear in such patients. Although aggressive diuretic therapy may induce hemoconcentration, hemoglobin change during hospitalization remains to be investigated.
Methods and Results: We analyzed the hemoglobin levels at admission and 24 h postadmission in 237 consecutive AHFS patients (74± 12 years, 60.8 % men). Patients with shock, hemodialysis, bleeding, surgery during hospitalization and urgent coronary angiography were excluded. APE was defined as an acute onset of dyspnea within the preceding 6 h which required mechanical ventilation treatment. At admission, the hemoglobin levels were higher in patients with APE (N=30) than those without APE (N=207, 13.3 ± 2.2 vs 12.2 ± 2.1 g/dL, p<0.01). Although diuretic therapy was performed in 232 patients (97.9%) during initial 24 h(resulted in median fluid output of 1550 mL), hemoglobin levels acutely decreased in 173 patients (73%), suggesting hemoglobin changes in this period was not due to fluid output but possibly due to fluid shift within the body. In patients with APE, the hemoglobin levels decreased dramatically (-1.8 ± 1.1 g/dL decrease within initial 24h) in comparison with those without APE (-0.5 ± 1.0 g/dL decrease, p<0.001), reflecting remarkable fluid shift in patients with APE. Both an acute onset within 6 h (age, sex, and baseline hemoglobin- adjusted odds ratio (OR) 2.17; 95% confidence interval (CI); 1.07 - 4.41, p= 0.03) and mechanical ventilation use (OR; 4.862, 95 % CI; 2.02 - 11.69, p<0.001) was independently associated with the early remarkable hemoglobin decrease (<-1.0 g/dL within 24h).
Conclusions: The hemoglobin levels acutely decreased in many AHFS patients. The changes in hemoglobin in early phase do not necessarily reflect volume overload but also possible fluid shift within the body, which was more prominent in patients with APE. APE patients were in paradoxically hemoconcentrated status at admission. Our findings may be potentially useful in selecting diuretic strategy.
- © 2013 by American Heart Association, Inc.