Plasma Volume Status and Its Association With In-Hospital and Postdischarge Outcomes in Decompensated Heart Failure

Marat Fudim, Joseph B. Lerman, Courtney Page, Brooke Alhanti, Robert M. Califf, Justin A. Ezekowitz, Nicolas Girerd, Justin L. Grodin, Wayne L. Miller, Ambarish Pandey, Patrick Rossignol, Randall C. Starling, W. H.Wilson Tang, Faiez Zannad, Adrian F. Hernandez, Christopher M. O'connor, Robert J. Mentz

Research output: Contribution to journalArticlepeer-review


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 postdischarge clinical outcomes, in the ASCEND-HF trial. Methods and Results: The 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. There were 6373 (89.2%), and 6354 (89.0%) patients who 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 N-terminal prohormone BNP, and with measures of decongestion such as body weight change and urine output (r < 0.3 for all). Duarte-ePV was trending toward an association with worse 30-day (adjusted odds ratio 1.07, 95% confidence interval [CI] 1.00–1.15, P = .058), but not 180-day outcomes (adjusted hazard ratio 1.03, 95% CI 0.97–1.09, P =. 289). A continuous KH-ePVS of >0 (per 10-unit increase) was associated with improved 30-day outcomes (adjusted odds ratio 0.75, 95% CI 0.62–0.91, P = .004). The continuous KH-ePVS was not associated with 180-day outcomes (adjusted hazard ratio 1.05, 95% CI 0.98–1.12, P =. 139). Conclusions: Baseline PV estimates had a weak association with in-hospital measures of decongestion. The Duarte-ePV trended toward an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF.

Original languageEnglish (US)
Pages (from-to)297-308
Number of pages12
JournalJournal of Cardiac Failure
Issue number3
StatePublished - Mar 2021


  • Heart failure
  • congestion
  • plasma volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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