Estimated plasma volume is not a robust indicator of the severity of congestion in patients with heart failure

Impact of estimated plasma volume status on postoperative outcomes in patients undergoing open abdominal aortic aneurysm repair

BACKGROUND

Major surgeries often lead to significant insensible fluid losses, posing challenges in achieving optimal fluid balance. Estimated plasma volume status (ePVS), calculated using the Kaplan-Hakim formula from hemoglobin and hematocrit values, serves as a marker for volume status and has been associated with adverse outcomes in various medical conditions. This study aims to explore the correlation of preoperative ePVS with postoperative outcomes in patients undergoing open abdominal aortic aneurysm (AAA) repair.

METHODS

This retrospective cohort study included 329 patients who underwent open AAA repair between 2018 and 2023, requiring intensive care unit admission for more than 24 hours. Data were included demographic information, comorbid conditions, preoperative laboratory values, intraoperative data, and postoperative outcomes. ePVS was calculated preoperatively and its association with postoperative outcomes was analyzed using statistical tests including student's t-test, chi-square test.

RESULTS

Patients with preoperative ePVS at or above the median (-11.5) had significantly higher rates of postoperative vasopressor support (P = .003), thrombotic events (P = .008), reintubation (P = .004), and sepsis (P = .044). ePVS at or above the median was also associated with longer surgery duration (P = .011). Multivariable logistic regression identified ePVS as an independent predictor of major postoperative complications (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.019-1.078; P = .001) and 30-day operative mortality (OR, 1.042; 95% CI, 1.000-1.083; P = .038).

CONCLUSIONS

Preoperative ePVS can be a predictor of postoperative outcomes in patients undergoing open AAA repair. Higher preoperative ePVS is associated with increased risk of complications and 30-day mortality.

Digoxin is Not Related to Mortality in Patients with Heart Failure: Results from the SELFIE-TR Registry

AIMS

Digoxin has been used in the treatment for heart failure for centuries, but the role of this drug in the modern era is controversial. A particular concern is the recent observational findings suggesting an increase in all-cause mortality with digoxin, although such observations suffer from biased results since these studies usually do not provide adequate compensation for the severity of disease. Using a nationwide registry database, we aimed to investigate whether digoxin is associated with 1-year all-cause mortality in patients with heart failure irrespective of phenotype.

METHODS

A total of 1014 out of 1054 patients in the registry, of whom 110 patients were on digoxin, were included in the study. Multivariable adjustments were done and propensity scores were calculated for various prognostic indicators, including signs and symptoms of heart failure and functional capacity. Crude mortality, mortality adjusted for covariates, mortality in the propensity score-matched cohort, and Bayesian factors (BFs) were analyzed.

RESULTS

Crude 1-year mortality rate did not differ between patients on and off digoxin (17.3% vs 20.1%, log-rank p = 0.46), and digoxin was not related to mortality following multivariable adjustment (hazard ratio 0.87, 95% confidence interval 0.539-1.402, p = 0.57). Similarly, all-cause mortality was similar in 220 propensity-score adjusted patients (17.3% vs 20.0%, log-rank p = 0.55). On Bayesian analyses, there was moderate to strong evidence suggesting a lack of difference between in unmatched cohort (BF10 0.091) and weak-to-moderate evidence in the matched cohort (BF10 0.296).

CONCLUSIONS

In this nationwide cohort, we did not find any evidence for an increased 1-year mortality in heart failure patients on digoxin.