Higher Level at Admission and Subsequent Decline in Hemoglobin in Patients With Acute Pulmonary Edema

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  • Konishi Masaaki
    Division of Cardiology, Yokohama City University Medical Center
  • Matsuzawa Yasushi
    Division of Cardiology, Yokohama City University Medical Center
  • Suzuki Hiroyuki
    Division of Cardiology, Yokohama City University Medical Center
  • Akiyama Eiichi
    Division of Cardiology, Yokohama City University Medical Center
  • Iwahashi Noriaki
    Division of Cardiology, Yokohama City University Medical Center
  • Maejima Nobuhiko
    Division of Cardiology, Yokohama City University Medical Center
  • Endo Mitsuaki
    Division of Cardiology, Yokohama City University Medical Center
  • Tsukahara Kengo
    Division of Cardiology, Yokohama City University Medical Center
  • Hibi Kiyoshi
    Division of Cardiology, Yokohama City University Medical Center
  • Kosuge Masami
    Division of Cardiology, Yokohama City University Medical Center
  • Ebina Toshiaki
    Division of Cardiology, Yokohama City University Medical Center
  • Sakamaki Kentaro
    Department of Biostatistics and Epidemiology, Yokohama City University Medical Center
  • Morita Satoshi
    Department of Biostatistics and Epidemiology, Yokohama City University Medical Center
  • Umemura Satoshi
    Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
  • Kimura Kazuo
    Division of Cardiology, Yokohama City University Medical Center

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Background: Acute pulmonary edema (APE) often occurs without remarkable fluid retention, and the benefits of diuretics are unclear in such patients. Although aggressive diuresis induces an increase in intravascular substances including hemoglobin (Hb), acute changes in Hb level remain to be investigated. Methods and Results: We analyzed 237 consecutive acute heart failure patients (74±12 years; 60.8% men) without shock, hemodialysis, bleeding, or urgent coronary angiography. APE was defined as acute onset of dyspnea within the preceding 6h and radiographic alveolar edema requiring immediate airway intervention. At admission, Hb level was higher in APE (n=29) than non-APE patients (n=208; 13.4±2.2 vs 12.2±2.1g/dl, P<0.01). Although diuretic therapy was performed in 232 patients (97.9%), hemoconcentration (ie, any increase in Hb) was observed in only 64 patients (27.0%) at 24h after admission. Conversely, Hb level decreased in both groups and the difference was larger in APE patients (−1.8±1.1 in APE and −0.5±1.0g/dl in non-APE patients, P<0.001). APE was significantly related to a greater decrease in Hb after adjusting for baseline Hb (β=−1.08g/dl, SE=0.20, P<0.001, ANCOVA). Conclusions: APE patients had higher Hb level at admission and a more remarkable decline in 24h than did those without APE. Acute change in Hb might be caused by factors other than diuresis-induced hemoconcentration. The present findings may be useful in the selection of diuretic strategies.  (Circ J 2014; 78: 896–902)<br>

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  • Circulation Journal

    Circulation Journal 78 (4), 896-902, 2014

    一般社団法人 日本循環器学会

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