Hemoconcentration Research Articles

Hemoconcentration is a valuable predictor of prognosis in patients with acute heart failure.

The present study was designed to investigate the value of the hemoconcentration (HCT) in predicting the prognosis of patients with acute heart failure (AHF). A total of 188 patients with AHF were enrolled in the present retrospective study and divided into four groups based on their HCT values. The endpoint was either cardiac-associated death or re-hospitalization due to aggravated HF. The 2-year survival rates of patients in these four groups were compared. The area under the receiver operating characteristic curve (AUC) was determined to evaluate the significance of HCT for assessing the prognosis of patients with AHF. Cox-proportional hazards regression models were performed to determine whether the HCT is an independent factor for predicting the prognosis of patients with AHF in comparison with other traditional predictors, including B-type natriuretic peptide (BNP) and creatinine. Of these 188 patients with AHF, 99 experienced aggravated cardiac HF resulting in death or re-hospitalization within 2 years. The AUC for HCT, as a prognostic criterion, was 0.610 (95% confidence interval: 0.528-0.691, P<0.001) with a sensitivity of 54.5% and a specificity of 65.2%. Kaplan-Meier analysis indicated that patients with a higher HCT had a lower rate of death or re-hospitalization due to cardiogenic events (χ2=9.442, P=0.024). Cox regression analysis revealed that HCT, hemoglobin, BNP, New York Heart Association cardiac function classification and serum creatinine were independent prognostic factors in AHF. HCT may serve as a valuable predictor of prognosis in patients with AHF. Compared with that of BNP, measurement of the HCT is more convenient and economical and may be widely performed at primary hospitals.

Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure.

Background:Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF.Methods:This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively.Results:The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07–1.18, P = 0.08).Conclusions:Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.

Worsening or ‘pseudo-worsening’ renal function? The prognostic value of hemoconcentration in patients admitted with acute heart failure

IntroductionRenal insufficiency, as evidenced by an increase in creatinine, is associated with higher mortality in patients with acute heart failure (AHF). Conversely, hemoconcentration (HC) in AHF is associated with lower mortality, but can also cause an increase in creatinine. Our aim was to assess the prognosis of HC in patients hospitalized for AHF presenting with or without worsening renal function (WRF). MethodsA total of 618 consecutive patients admitted for AHF were included. WRF was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria and HC was defined as an elevation of hemoglobin during hospitalization compared to the admission value. Six-month all-cause mortality was analyzed. ResultsThe patients’ mean age was 79±11 years; 58% were women. Mortality at six months was 38% and 49% of patients had WRF. HC occurred in 38.9% of patients with WRF and was associated with improved survival (HR 1.6, 95% CI 1.10-2.34; p=0.02) compared to WRF without HC. HC was associated with better survival in KDIGO stages 1 and 2 (HR 1.8; 95% CI 1.1-2.8; p=0.01). For patients without chronic kidney disease (CKD) with WRF in stages 1 and 2, HC was associated with significantly better survival (HR 2.3; 95% CI 1.2-4.2; p=0.01). ConclusionIn patients admitted for AHF without renal failure or CKD, WRF with HC is associated with a better prognosis, similar to that of patients without WRF, and should therefore be reclassified as ‘pseudo-WRF’.

Stroke as Fatal complication of Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome is a condition related to injectable hormonal medications used for stimulation the maturation of oocytes in infertility caused by lack of or delayed ovarian maturation. The incidence increased due to wide spread expansion of hormonal stimulation use. The scale of symptoms of this condition varies from mild outpatient managed symptoms as vomiting and bloating to sever fatal complication as hemocon centration, fluid overload, hypercoagulability, and multisystem organ failure. The main point of management is prevention and exclude the candidates with elevated risk of the condition. Here we present a case of 30-year-old woman who had ovarian hyperstimulation syndrome with rare but severe complications.

Abstract 12269: Prognostic Role of Hemoconcentration in Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction; an Analysis From Mode of Death

Backgrounds: Hemoconcentration (HC) during heart failure treatment is known to be associated with improved clinical outcome in patients with acute decompensated heart failure (ADHF). There is a difference in mode of death (cardiac [sudden vs pump failure death] vs non-cardiac death) between heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF). However, there is no information available on the different impact of HC in the prediction of mode of death in ADHF patients, relating to HFpEF and HFrEF. Methods and Results: We studied 302 patients admitted with ADHF and discharged with survival (HFpEF(LVEF≥50%);n=139, HFrEF(LVEF&lt;50%); n=163). HC was defined as an increase in hemoglobin level from admission to discharge. During a follow-up period of 5.1±4.3 yrs, 65 patients had cardiac death (sudden cardiac death in 37 and pump failure death in 27 patients) and 56 patients had non-cardiac death. HC was significantly associated with cardiac death in patients with HFrEF (p=0.02) but not in those with HFpEF, while there were no associations between HC and non-cardiac death in both patients with HFpEF and HFrEF. In patients with HFrEF, although there was no association between HC and sudden cardiac death, HC was significantly associated with pump failure death (adjusted HR 0.31 [95%CI 0.10-0.91], p=0.04), independently of relevant covariates such as systolic blood pressure and BUN. On the other hand, there was no association between HC and sudden or pump failure death in patients with HFpEF. Conclusion: HC was related to improve pump failure death but not sudden cardiac death in hospitalized ADHF patients with HFrEF, not in those with HFpEF. This finding about clinical implication of HC might provide a new insight to decongestive therapy of ADHF in terms of LVEF.

PROGNOSTIC VALUE OF HEMOCONCENTRATION IN ACUTE DECOMPENSATED HEART FAILURE WITH PRESERVED AND REDUCED EJECTION FRACTION: DATA FROM THE KOREAN HEART FAILURE (KORHF) REGISTRY

Hemoconcentration (HC) during hospitalization was known to be related with improved clinical outcomes in patients (pts) with acute decompensated heart failure (ADHF). However, there have not been any reports about the different impact of HC in the prediction of clinical outcomes in HF with preserved

PROGRESSIVE HYPONATREMIA DURING HEART FAILURE TREATMENT PROVIDES ADDITIONAL LONG-TERM PROGNOSTIC INFORMATION TO HEMOCONCENTRATION IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE

Hemoconcentration (HC) during heart failure treatment is known to be associated with decreased mortality and rehospitalization in patients (pts) with acute decompensated heart failure (ADHF). On the other hand, progressive hyponatremia (pro-hypoNa) during hospitalization is reported to be associated

Exercise before Scuba Diving Ameliorates Decompression-Induced Neutrophil Activation

The goals of this study were to investigate the difference in responses between a scuba dive preceded by aerobic exercise (EX) and a nonexercise control dive (CON) and to further evaluate the potential relation between venous gas emboli (VGE) and microparticles (MP). We hypothesized that exercise would alter the quantity and subtype of annexin V-positive MP and VGE. Nineteen divers performed two dives to 18 m seawater for 41 min separated by at least 3 d, one of which was preceded by 60 min of treadmill interval exercise. Blood was obtained before exercise, before diving, and 15 min, 2 h, 4 h, and 24 h after surfacing. Intravascular bubbles were quantified by transthoracic echocardiography at 15, 40, 80, and 120 min. The median VGE remained unchanged between the two dives; however, there was a significant increase in VGE in the exercise dive at 40 and 80 min at rest. MP were significantly elevated by approximately 2 times at all time points after CON compared with those after EX. Markers of neutrophil and platelet activation were elevated by both dives, and these elevations were attenuated in the EX dive. We conclude that some of the differences observed between the EX and CON related to MP and platelet and neutrophil activation provide additional insight into the potential protective benefits of exercise; however, further study is needed to understand the mechanism and true potential of these benefits.

THE RELATIONSHIP BETWEEN HEMOCONCENTRATION AND HYPONATREMIA ON CLINICAL OUTCOMES IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE: DATA FROM THE KOREAN HEART FAILURE (KORHF) REGISTRY

Hemoconcentration (HCT) and hyponatremia were known to be related with mortality and morbidity in patients (pts) with acute decompensated heart failure (ADHF), respectively. However, the relationship between HCT and hyponatremia in the prediction of clinical outcomes in ADHF remains unknown until

Blood rheology at term in normal pregnancy and in patients with adverse outcome events

Plasma volume expansion of more than 1.5 l and sustainable activation of the hemostatic system that results in a steady rise of the fibrinogen/fibrin turnover are contemporary physiological events during normal pregnancy. In contrast, adverse outcome of pregnancy i.e. pre-eclampsia commonly coincide with hemo concentration and over activation of blood coagulation both of which alter blood rheology. On the basis of 4,985 consecutively recorded singleton pregnancies values range of blood rheological parameters in women with normal and complicated outcome of pregnancy at the time of their delivery were compared. Plasma viscosity (pv) was determined using KSPV 1 Fresenius and RBC aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne. Seventy-nine point four percent (n=3,959) had normal pregnancy outcome and 1,026 with adverse outcome of pregnancy had pre-eclampsia (8.4%; n=423), had newborn with a birth-weight < 2,500 g (9.5%; n=473), had early-birth before week 37 (9.3%; n=464), and/or were diagnosed with intra uterine growth retardation (IUGR) (5.0%; n=250). In women with normal pregnancy outcome mean (+/-SD) of pv was 1.31+/-0.09 mPa s, of E0 was 21.6+/-5.3, and of E1 was 38.4+/-7.9 while in women with adverse outcome means for rheological parameters were statistically significantly different i.e. pv: 1.32+/-0.08 mPa s; p=0.006, E0: 22.1+/-5.5; p=0.002 and E1: 39.5+/-8.5; p=0.0006. Subgroup analysis revealed statistical significant lower pv in women who either had pre term delivery or a low birth-weight child (p<0.005) as compared to women who had normal pregnancy outcome while patients with pre-eclampsia had markedly higher low shear and stasis RBC aggregation (p<0.0001). None of the rheological results at term were correlated with either maternal age (r<0.04), BMI (r<0.09), maternal weight gain until delivery (r<0.04), or fetal outcome such as APGAR-score (r<0.09) art. pH in the umbilical cord (-0.05<r<0.04), fetal birth-weight (r<0.04). Women who did vs. did not receive iron supplementation during pregnancy had lower pv (p<0.0001) and higher E0 (p<0.01) while smokers vs. non-smokers had lower E0 (p=0.0002). There was a strong correlation between hemoglobin concentrations and pv at term (spearman r=0.15; p<0.0001). To our knowledge this is the largest trial that consecutively assessed blood rheological parameters in pregnant women at term. Distribution of pv and RBC aggregation was studied in women with normal and complicated pregnancy. We found lower pv and increased RBC aggregation in patients with different adverse outcome of pregnancy compared to normal pregnancy. Interestingly, in pre-eclampsia hemo concentration and increased fibrinogen turnover due to enhanced coagulation activation are weighty co factors of pv but were associated with lower pv in patients with pre-eclampsia. However, coincidental increased RBC aggregation and hemo concentration may potentially derogate blood flow in the materno-fetal unit that is commonly traceable using vessel duplex ultra sound in pre-eclampsia.

HEMOLEUCOGRAM CHANGES ON CALVES WITH NEONATAL DIARRHEA TREATED WITH PROPOLIS TINCTURE, MINT AND BILBERRY EXTRACTS

SUMMARY Because of increased morbidity and mortality, the n eonatal diarrhea syndrome represents one of the main problems with economical lasts found in youth bovine breeding. Ecological farms are starting to develop in Romania and the use of antibiotics and chemioterapics will soon be restricted. In this study we tried to replace the classical the rapy with fitotherapy, in the classical treatment of neonatal diarrhea syndrome on calves. The calves taken into study presented variable inte nsity of diarrhea discharges. The treatment was made for six days, twice daily with 5 ml of plant extracts (3). The blood samples were taken before, during and after treatme nt and the results were presented as medium values. Following fluids lost by diarrhea and hemoconcentra tion, hemoglobin value was 11,63 mg/dl. After three days of treatment the value decr eased at 10,3 mg/dl, respectively after six days at 10,1 mg/dl, these values being between phys iological limits. The evolution of hematocrit is directly correlated with hemoglobin a nd erythrocytes number. At the beginning of the study hematocrit was 55,4% and at the end of treatment 38,1% that is between normal limits (1, 2). The variation of leukocyte formula is in concordanc e with the literature, a slightly increase in lymphocytes number being noticed at the beginning of the treatment. Concerning monocytes, basophiles and eosinophiles their values were between, physiological limits. In conclusion, these plant extracts have shown effi ciency in 85 % of the cases from this study. Because these natural products do not c ontain any antibiotic or chemiotherapic residues, the ecological farms have a real interest for them. Also, these products have a long period of preservation.

HEMOCONCENTRATION ALONE IS AN UNRELIABLE PREDICTOR OF MORTALITY IN ACUTE PANCREATITIS

Purpose: To examine whether hemoconcentration (HC) at admission predicts in-hospital mortality in acute pancreatitis (AP). To determine whether a new definition of intravascular volume depletion [Hgb + BUN] is a better predictor for in-hospital mortality. Methods: Patient data was generated from the Cardinal Health Research Database, a large population dataset. All cases from Jan 2004 - Dec 2004 with principal diagnosis ICD9-CM 577.0 (AP) were included. Two cohorts of patients were identified: transferred vs. non-transferred pts. HC was defined as elevated hgb> 14.6 g/dL (hct 44%). The combination of elevated hgb >14.6 g/dL and BUN > 25 mg/dL (Hgb + BUN) was used as a marker for intravascular volume depletion. Comparison was made between HC and our newly defined marker of intravascular volume depletion for prediction of in-hospital mortality in the two cohorts. Results: There were a total of 202 transferred and 17,852 non-transferred cases of AP. Overall mortality was 5.5% vs 1.2% in transferred vs. non-transferred pts respectively (p < 0.001 2). HC was a significant risk factor for mortality only among transferred pts. Combined (Hgb + BUN) was a significant predictor of mortality in both cohorts. Admission intravascular volume depletion as assessed by our new criteria was significantly more common among transferred vs non-transferred pts. (9.4% vs. 2.8%, p < 0.001 2). (Table 1)TABLE 1: Caption not available.Conclusion: Hemoconcentration alone is an unreliable predictor of mortality in AP. Hgb + BUN was a more robust predictor of mortality for both transferred and non-transferred pts. These findings help explain discordant results from previous studies of hemoconcentration in AP.

Hemoconcentration Alone Is an Unreliable Predictor of Mortality in Acute Pancreatitis

Purpose: To examine whether hemoconcentration (HC) at admission predicts in-hospital mortality in acute pancreatitis (AP). To determine whether a new definition of intravascular volume depletion [Hgb + BUN] is a better predictor for in-hospital mortality. Methods: Patient data was generated from the Cardinal Health Research Database, a large population dataset. All cases from Jan 2004–Dec 2004 with principal diagnosis ICD9-CM 577.0 (AP) were included. Two cohorts of patients were identified: transferred vs. non-transferred pts. HC was defined as elevated hgb > 14.6 g/dL (hct 44%). The combination of elevated hgb > 14.6 g/dL and BUN > 25 mg/dL (Hgb + BUN) was used as a marker for intravascular volume depletion. Comparison was made between HC and our newly defined marker of intravascular volume depletion for prediction of in-hospital mortality in the two cohorts. Results: There were a total of 202 transferred and 17,852 non-transferred cases of AP. Overall mortality was 5.5% vs 1.2% in transferred vs. non-transferred pts respectively (P < 0.001 χ2). HC was a significant risk factor for mortality only among transferred pts. Combined (Hgb + BUN) was a significant predictor of mortality in both cohorts. Admission intravascular volume depletion as assessed by our new criteria was significantly more common among transferred vs non-transferred pts. (9.4% vs. 2.8%, P < 0.001 χ2). Conclusion: Hemoconcentration alone is an unreliable predictor of mortality in AP. Hgb + BUN was a more robust predictor of mortality for both transferred and non-transferred pts. These findings help explain discordant results from previous studies of hemoconcentration in AP.Table: Mortality Comparisons

Evidence for distinct systemic extravasation effects of platelet activating factor, leukotrienes B 4, C 4, D 4 and histamine in the guinea pig

The relative potencies of platelet-activating factor (PAF), leukotrienes B 4 (LTB 4), C 4 (LTC 4), D 4 (LTD 4) and histamine to induce hemoconcentration (HC) were evaluated in the guinea pig. The maximal hematocrit increase (MHI) from PAF, LTD 4 and histamine occurred 5–7 min after i.v. injection, whereas the MHI of LTC 4 Occurred 13–15 min after injection. LTB 4 (2.97–5.95 nmol kg −1) did not produce HC. The magnitude of PAF-induced MHI was 2-fold that of LTC 4 or LTD 4, regardless of the dose of leukotrienes used. The doses (nmol kg −1) needed to produce 30% HC were: 0.14-PAF, 0.71-L.TD 4 and 3.37-LTC 4 and 2,400 histamine. The HC effects of LTD 4 were markedly reduced by prior administration of FPL-55712. However, neither LTC 4 or LTD 4 HC effects were significantly reduced by prior i.v. injection of CV-3988 (3.4 mg kg −1), a competitive receptor antagonist to PAF which is 98% effective in abolishing HC response to 0.14 nmol kg −1 PAF. Diphenhydramine abolished histamine-induced hemoconcentration but was without effect on PAF or LTD4. These results suggest that the responses of PAF, leukotrienes and histamine differ in their potency and may involve separate vascular recognition sites related to acute increases in vascular permeability.

IDIOPATHIC APNEA OF INFANCY: POST-NEONATAL SYNDROME

None had received a prior course of magnesium (Mg) supplements, There were two groups: 1) 29 premature infants of 31.5±0.6 wk. gestation age (mean±SEM) and 1462±99 g birth wt., who had idiopathic apnea as neonates, were apparently well when discharged, and suddenly had apnea at 70.6±6 days of age; and 2) 22 infants of 39.9 wk. gestation age and 3293±150 g birth wt., with an onset of apnea at 49.6±12 days of age. Initial findings were similar in 1) and 2), except for lower hemoglobin in 1). Over 50% of the 51 infants had cyanosis, mucus secretions, extremes in heart rate on EKG, respiratory distress, and neuromuscular irritability. Over 20% had intermittent hypertonicity. The clinical chemistry profile often showed a shock pattern: metabolic acidosis, hypoxemia, hemocon centration, hyperkalemia, hyperchloremia, hyperglycemia, elevated glucose and/or protein in cerebrospinal fluid and urine, and abnormal urinary sediment. These were transient changes; many normalized in 24-48 hrs. About 60% of chest X-rays showed pulmonary infiltrates or hyperinflation. There was usually high retention of an IM Mg load. Four died. Within a narrow time frame, Mg deficient weanling rats experience a syndrome similar to that of the infants in respect to physical, chemical, EKG, and lung changes; and mortality. Mg deficient dog pups have similar attacks. Mg deficiency may be a cause of the syndrome in infants. Mg deficiency is preventable; the matter deserves careful study.

Cerebrospinal Fluid Pressure, Growth, and Hematology in Relation to Retinol Status of the Rat in Acute Vitamin A Deficiency

JOYCE E. COREY AND K. C. HAYESDepartment of Nutrition, Harvard School of Public Health,Boston, Massachusetts 02135ABSTRACT In order to produce a model with which to isolate the primarychanges associated with vitamin A deficiency in the weanling rat, cerebrospinalfluid (CSF) pressure, body weight gain, and hA©matologieresponses were characterized in two experiments. In experiment 1, 35 weanling male rats were fedgraded intakes of vitamin A for a 5-week comparison method. It was predictedon the basis of linear regressions that the CSF pressure should be the mostsensitive of the three parameters to marginal vitamin A intake. To establish thissensitivity of the CSF pressure elevation in temporal terms during the onset ofacute deficiency, 48 weanling male rats were either fed ad libitum a vitamin A-free basal diet or the basal diet supplemented with vitamin A or pair-fed thecontrol diet. The three parameters described above were measured during the15 days critical to the development of deficiency. The data indicate that the risein CSF pressure in acute deficiency was not as sensitive to the onset of deficiencyas had been predicted on the basis of marginal or chronic deficiency. Thesestudies suggest that an acute deficiency does not allow sufficient time for theelevation of the CSF pressure due to an abrupt and disruptive metabolic imbalance apparently involving water. The implications of using a study of acuteor chronic vitamin A deficiency as a model for experimental investigation arediscussed. J. Nutr. 102: 1585-1594, 1972.INDEXING KEY WORDS vitamin A deficiency •cerebrospinal fluid pressure •hemo concentration