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

BackgroundSystemic 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.ObjectivesTo 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.MethodsThe 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.Results36.6% had a BNP>400pg/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).ConclusionHigher 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.