[Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure]. / Determinantes clínicos y valor pronóstico de la hemoglobina en pacientes hospitalizados con insuficiencia cardiaca sistólica.

INTRODUCTION AND OBJECTIVES: Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level. METHODS: The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction <45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months. RESULTS: Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011-1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083-3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087-1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005-1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463-5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103-1.375; P<.001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058-1.255; P<.001), but not with readmission for non-fatal HF (RR per g/dL=1.081, 95% CI, 0.962-1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40-3.41; P=.001). CONCLUSIONS: In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics.

Determinantes clínicos y valor pronóstico de la hemoglobina en pacientes hospitalizados con insuficiencia cardiaca sistólica / Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure

Introducción y objetivos. En pacientes ambulatorios con insuficiencia cardiaca, la anemia es frecuente y se asocia con un aumento de la mortalidad. Estudiamos los determinantes del valor de hemoglobina y su valor pronóstico a medio plazo en una población amplia de pacientes hospitalizados con IC sistólica. Métodos. Se incluyó a 460 pacientes consecutivos (68,3 ± 12,3 años, 74% varones) hospitalizados con el diagnóstico de insuficiencia cardiaca y disfunción sistólica (fracción de eyección del ventrículo izquierdo [FEVI] < 45%). En el momento del alta hospitalaria se realizaron las determinaciones bioquímicas y hematológicas y se recogieron las variables clínicas y ecocardiográficas. Los pacientes fueron seguidos durante 16,8 ± 9,7 meses. Resultados. Un total de 189 (41,1%) pacientes presentaban anemia (según la definición de la Organización Mundial de la Salud). Los determinantes independientes del valor de hemoglobina fueron la edad (riesgo relativo [RR] = 1,035; intervalo de confianza [IC] del 95%, 1,011-1,060; p = 0,004), el sexo femenino (RR = 1,843; IC del 95%, 1,083-3,135; p = 0,024), diabetes mellitus (RR = 1,413; IC del 95%, 1,087-1,838; p = 0,010), urea plasmática (RR = 1,013; IC del 95%, 1,005-1,022; p = 0,001) y diuréticos del asa (RR = 2,801; IC del 995%, 1,463-5,364; p = 0,002). Un menor valor de hemoglobina se asoció con un mayor riesgo de muerte evento (RR = 1,232; IC del 95%, 1,103-1,375; p < 0,001) y del evento combinado de muerte o reingreso por insuficiencia cardiaca (RR = 1,152; IC del 95%, 1,058-1,255; p < 0,001), pero no de reingreso por insuficiencia cardiaca no fatal (RR = 1,081; IC del 95%, 0,962-1,215; p = 0,265). La transfusión de hematíes durante el ingreso no modificó el incremento del riesgo de muerte (RR = 2,19; IC del 95%, 1,40-3,41, p = 0,001). Conclusiones. En pacientes hospitalizados con IC sistólica, el valor de hemoglobina en el momento del alta es un predictor independiente de mortalidad a medio plazo, pero no de reingresos por IC no fatal. Sus principales determinantes fueron la edad, el sexo, la función renal, la diabetes y la necesidad de diuréticos (AU)

Introduction and objectives. Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level. Methods. The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction < 45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months. Results. Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011–1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083–3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087–1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005–1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463–5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103–1.375; P < 001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058–1.255; P < .001), but not with readmission for nonfatal HF (RR per g/dL=1.081, 95% CI, 0.962–1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40–3.41; P=.001). Conclusions. In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics (AU)