Study On The Value Of Estimated Plasma Volume In The Diagnosis And Prediction Of Hospitalization Death Of Acute Heart Failure In Elderly Patients With Dyspnea

Objective:To explore the diagnostic value of plasma volume(ePVS)calculated from blood samples of elderly patients with acute dyspnea at the time of emergency admission for acute heart failure(AHF)and its predictive value of hospital death.Methods:From January 2020 to June 2021,600 elderly patients with acute dyspnea who were treated in the emergency department of Fenyang Hospital in Shanxi Province were retrospectively analyzed.They were divided into AHF group(289 cases)and NAHF group(311 cases).We collected and compared the basic clinical data of the two groups of patients.We measured NT-pro BNP,sex,age,medical history,vital signs,blood potassium,blood sodium,serum creatinine,hemoglobin,hematocrit,N-terminal B-type natriuretic peptide(NT-pro BNP)and blood gas value.ePVS was calculated according to hemoglobin and hematocrit using Duarte formula.The statistically significant indicators between the two groups were included in the multivariate logistic regression analysis to evaluate the relationship between ePVS and the incidence of AHF in hospitalized patients with acute dyspnea.Then we compared the difference between different NYHA grades and the difference between the admission ePVS and NT-pro BNP between the NAHF groups.Spearman correlation analysis was used to evaluate the correlation between ePVS and cardiac function.According to whether AHF patients died in hospital,they were divided into death group of 33 cases and survival group of 256 cases.The ePVS and NT-pro BNP values of the two groups were compared.We also drawed the subject working characteristic(ROC)curve,and determined the value of ePVS,NT-pro BNP and their combination in the diagnosis of AHF in elderly patients with dyspnea and the predictive value of AHF death in hospital.Then we used Medcal software to compare the size of different AUC.Results:1.The value of admitted ePVS in AHF group was higher than that in NAHF group[5.51(4.74,6.28)vs.3.91(3.30,4.46),P<0.05],and the level of NT-pro BNP in AHF group was higher than that in NAHF group [4988(2221,12633)vs.444.9(134.8,1436),P<0.05].High admission ePVS,high NT-pro BNP,high blood potassium,combined history of heart failure and coronary heart disease were independent risk factors for the occurrence of AHF in patients with dyspnea.ROC curve showed that the AUC of AHF in patients with ePVS dyspnea was 0.822(95%CI 0.790-0.852,P<0.05)and that of NT-pro BNP was 0.874(95%CI 0.845-0.899,P<0.05).The AUC of the combination was 0.914(95%CI 0.790-0.852,P<0.05).By comparison,the AUC value of ePVS combined with NT-pro BNP was greater than that of NT-pro BNP(Z=2.468,P<0.05)and ePVS(Z=5.335,P<0.05),and the difference was statistically significant.The AUC value of NT-pro BNP was greater than ePVS,and the difference was statistically significant(Z=2.260,P<0.05).2.Among 289 patients with AHF in different NYHA groups,ePVS increased with the increase of NYHA grading,and the difference between groups was statistically significant(P<0.05).Correlation analysis showed that ePVS was correlated with NYHA cardiac function grade,and the correlation coefficient was 0.605(P<0.001).3.Among patients with AHF,the ePVS value in the death group was higher than that in the survival group and the NT-pro BNP level was higher than that in the survival group[6.20(5.34,7.98)vs.5.43(4.69,6.21),P<0.001],[15675(6302.5,34308.5)vs.4719(2203.5,10878.8),P<0.05].The ROC curve showed that the AUC of inpatient death predicted by admission ePVS was 0.711(95% CI 0.655-0.763,P<0.05),7.13 d L /g was the best cutoff value,NT-pro BNP was 0.734(95% CI 0.679-0.784,P<0.05),11368 ng /L was the best cutoff value,and the combined AUC was 0.860(95%CI 0.815-0.898,P<0.05).By comparison,the results showed that there was no statistical difference in the AUC value of ePVS and NT-pro BNP(P>0.05).The AUC value of the combination was greater than ePVS(Z=3.137,P<0.05)and NT-pro BNP(Z=2.689,P<0.05),and the difference was statistically significant.Conclusion:1.In-hospital ePVS>4.86 d L/g can be used as a rapid indicator to judge the occurrence of acute heart failure in elderly patients with dyspnea in the emergency department.Withou-t replacing NT-pro BNP,the combined determination of NT-pro BNP can further improve the diagnostic efficiency.2.High ePVS at admission is associated with worse cardiac function in AHF patients.3.In-hospital ePVS>7.13 d L/g is a risk factor for death in AHF patients.The combined determination of NT-pro BNP can better predict the risk of death in AHF patients.