Plasma Volume Status and its Association with In-Hospital and Post-Discharge Outcomes in Decompensated Heart Failure.

Abstract Background Prior analyses suggest an association between formula-based plasma volume (PV) estimates and outcomes in heart failure (HF). We assessed the association between estimated PV-status by the Duarte-ePV and Kaplan Hakim (KH-ePVS) formulas, and in-hospital and post-discharge clinical outcomes, in the ASCEND-HF trial. Methods and Results KH-ePVS and Duarte-ePV were calculated on admission. We assessed associations with in-hospital worsening HF, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality. 6,373 (89.2%), and 6,354 (89.0%), patients had necessary characteristics to calculate KH-ePVS and Duarte-ePV, respectively. There was no association between PV by either formula with in-hospital worsening HF. KH-ePVS showed a weak correlation with NT-proBNP, and with measures of decongestion such as body weight change and urine output (r 0 (per 10 unit increase) was associated with improved 30-day outcomes (adjusted-OR 0.75, 95%CI 0.62-0.91, p=0.004). Continuous KH-ePVS was not associated with 180-day outcomes (adjusted-HR 1.05, 95%CI 0.98-1.12, p=0.139). Conclusions Baseline PV estimates had a weak association with in-hospital measures of decongestion. Duarte-ePV, trended towards an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF.