Abstract 9373: Single Evaluation of Body Mass-Corrected Estimated Plasma Volume at Discharge Predicts Prognosis of Heart Failure Patients

Abstract

Background: Estimated plasma volume(ePV) is a parameter of body fluid volume trends in the same patient and also an indicator for residual congestion. Patients with heart failure often have difficulty achieving adequate body fluid volume. We investigated the post-discharge prognosis of heart failure patients with a one-time evaluation of ePV at discharge corrected for body mass index (BMI). Methods: This is a single-center, prospective observational study. A total of consecutive 1268 heart failure hospitalizations, excluding acute coronary syndromes, from January 2018 to December 2021 were included. We evaluated 767 patients, excluding repeat hospitalizations of the same patient (366 cases), in-hospital deaths (54 cases), transfers for cardiac surgery and forced discharges (39 cases), and missing data (42 cases). A prognosis investigation was conducted for patients who haven’t visited our hospital for more than one year. BMI and ePV (ml, Hakim's formula) were calculated from height, weight, and hematocrit at discharge. Survival analysis was performed with ePV divided by BMI (ePV/BMI). Primary endpoint was composite of all-cause mortality and heart failure re-hospitalization. Results: median of 372 days of post-discharge observation, 205 deaths, and 336 composite endpoints were observed. ePV/BMI was categorized into three quartiles [low group (65.34-96.8), middle group (96.9-111.9) and high group (112.0-175.8)]. Survival analysis by ePV/BMI three tertiles showed a combined endpoint of death + rehospitalization (48.8 vs 69.2 vs 74.9%, log-rank P<0.001) and death (11.7 vs 20.9 vs 24.7%, log-rank P<0.001) at three years, respectively. Multivariable Cox proportional hazard model with covariant univariable predictive factors (age, severe kidney dysfunction, beta-blocker, angiotensin-converting enzyme inhibitor, psychotropic or cognitive medicines, in-hospital blood transfusion, low nutritional status) shows higher ePV/BMI tertile (HR1.44, 95%CI:1.26-1.64, p<0.001), as well as the continuous variable of ePV/BMI (HR1.02, 95%CI:1.01-1.03, p<0.001), is a predictive factor of the composite endpoint. Conclusion: Even after therapeutic intervention, ePV/BMI at discharge is a useful predictor of heart failure outcome.