Rev Esp Cardiol. 2007;60(6):597-606 597 Introduction and objectives. Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level. Methods. The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction <45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months. Results. Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011–1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083–3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087–1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005–1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463–5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103–1.375; P<.001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058–1.255; P<.001), but not with readmission for non- fatal HF (RR per g/dL=1.081, 95% CI, 0.962–1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40–3.41; P=.001). Conclusions. In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of Clinical Determinants and Prognostic Value of Hemoglobin in Hospitalized Patients With Systolic Heart Failure Belén Redondo-Bermejo, a Domingo A. Pascual-Figal, a José A. Hurtado-Martínez, a Jorge Montserrat-Coll, b Pablo Peñafiel-Verdú, a Francisco Pastor-Pérez, a José A. Giner-Caro, a and Mariano Valdés-Chávarri a a Servicio de Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain b Servicio de Hematología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain ORIGINAL ARTICLE Correspondence: Dr. D.A. Pascual. Servicio de Cardiología. Unidad de Insuficiencia Cardiaca. Hospital Universitario Virgen de la Arrixaca. Benabia, 7. 30110 Murcia. España. E-mail: dapascual@servicam.com Received August 10, 2006. Accepted for publication March 1, 2007. the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics. Key words: Heart failure. Anemia. Hemoglobin. Prognosis. Determinantes clínicos y valor pronóstico de la hemoglobina en pacientes hospitalizados con insuficiencia cardiaca sistólica Introducción y objetivos. En pacientes ambulatorios con insuficiencia cardiaca, la anemia es frecuente y se asocia con un aumento de la mortalidad. Estudiamos los determinantes del valor de hemoglobina y su valor pro- nóstico a medio plazo en una población amplia de pa- cientes hospitalizados con IC sistólica. Métodos. Se incluyó a 460 pacientes consecutivos (68,3 ± 12,3 años, 74% varones) hospitalizados con el diagnóstico de insuficiencia cardiaca y disfunción sistó- lica (fracción de eyección del ventrículo izquierdo [FEVI] < 45%). En el momento del alta hospitalaria se realizaron las determinaciones bioquímicas y hematoló- gicas y se recogieron las variables clínicas y ecocardio- gráficas. Los pacientes fueron seguidos durante 16,8 ± 9,7 meses. Resultados. Un total de 189 (41,1%) pacientes presen- taban anemia (según la definición de la Organización Mundial de la Salud). Los determinantes independientes del valor de hemoglobina fueron la edad (riesgo relativo [RR] = 1,035; intervalo de confianza [IC] del 95%, 1,011- 1,060; p = 0,004), el sexo femenino (RR = 1,843; IC del 95%, 1,083-3,135; p = 0,024), diabetes mellitus (RR = 1,413; IC del 95%, 1,087-1,838; p = 0,010), urea plasmá- tica (RR = 1,013; IC del 95%, 1,005-1,022; p = 0,001) y diuréticos del asa (RR = 2,801; IC del 995%, 1,463-5,364; p = 0,002). Un menor valor de hemoglobina se asoció con un mayor riesgo de muerte evento (RR = 1,232; IC del 95%, 1,103-1,375; p < 0,001) y del evento combinado de muerte o reingreso por insuficiencia cardiaca (RR = 1,152; IC del 95%, 1,058-1,255; p < 0,001), pero no de reingreso por insuficiencia cardiaca no fatal (RR = 1,081; IC del 95%, 0,962-1,215; p = 0,265). La transfusión de hematíes durante el ingreso no modificó el incremento del riesgo de muerte (RR = 2,19; IC del 95%, 1,40-3,41, p = 0,001). Document downloaded from https://www.revespcardiol.org/, day 14/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 14/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.