Decrease of haemoconcentration reliably detects hydrostatic pulmonary oedema in dyspnoeic patients in the emergency department - a machine learning approach.
Augmented intelligence
Haemoconcentration
Haemodilution
Lung water
Pulmonary edema
Journal
International journal of emergency medicine
ISSN: 1865-1372
Titre abrégé: Int J Emerg Med
Pays: England
ID NLM: 101469435
Informations de publication
Date de publication:
05 Sep 2024
05 Sep 2024
Historique:
received:
02
07
2024
accepted:
26
08
2024
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
5
9
2024
Statut:
epublish
Résumé
Haemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (ED) setting still needs to be determined. In this observational retrospective monocentric study, ED patients admitted for acute dyspnoea were enrolled. Hb values were recorded both at ED presentation (T Seven-hundred-and-six dyspnoeic patients (203 HPO and 503 non-HPO) were enrolled over 19 months. Hb levels were significantly different between HPO and non-HPO patients both at T ΔHb
Sections du résumé
BACKGROUND
BACKGROUND
Haemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (ED) setting still needs to be determined.
METHODS
METHODS
In this observational retrospective monocentric study, ED patients admitted for acute dyspnoea were enrolled. Hb values were recorded both at ED presentation (T
RESULTS
RESULTS
Seven-hundred-and-six dyspnoeic patients (203 HPO and 503 non-HPO) were enrolled over 19 months. Hb levels were significantly different between HPO and non-HPO patients both at T
CONCLUSIONS
CONCLUSIONS
ΔHb
Identifiants
pubmed: 39237860
doi: 10.1186/s12245-024-00698-y
pii: 10.1186/s12245-024-00698-y
doi:
Types de publication
Journal Article
Langues
eng
Pagination
114Informations de copyright
© 2024. The Author(s).
Références
Lindskou TA, Pilgaard L, Søvsø MB, Kløjgård TA, Larsen TM, Jensen FB, et al. Symptom, diagnosis and mortality among respiratory emergency medical service patients. PLoS ONE. 2019;14:e0213145.
pubmed: 30817792
pmcid: 6395033
doi: 10.1371/journal.pone.0213145
Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med. 2005;353:2788–96.
pubmed: 16382065
doi: 10.1056/NEJMcp052699
Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the Emergency Department have congestive heart failure? JAMA. 2005;294:1944–56.
pubmed: 16234501
doi: 10.1001/jama.294.15.1944
Cairns C, Kang K, National Hospital Ambulatory Medical Care Survey. : 2019 Emergency Department Summary Tables [Internet]. National Center for Health Statistics (U.S.); 2022 Apr. https://stacks.cdc.gov/view/cdc/115748
Sørensen SF, Ovesen SH, Lisby M, Mandau MH, Thomsen IK, Kirkegaard H. Predicting mortality and readmission based on chief complaint in emergency department patients: a cohort study. Trauma Surg Acute Care Open. 2021;6:e000604.
pubmed: 34926831
pmcid: 8647536
doi: 10.1136/tsaco-2020-000604
Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989;261:884–8.
pubmed: 2913385
doi: 10.1001/jama.1989.03420060100040
Murray JF. Pulmonary edema: pathophysiology and diagnosis. Int J Tuberc Lung Dis. 2011;15:155–60.
pubmed: 21219673
Russell FM, Ehrman RR, Cosby K, Ansari A, Tseeng S, Christain E, et al. Diagnosing Acute Heart failure in patients with undifferentiated Dyspnea: a lung and Cardiac Ultrasound (LuCUS) Protocol. Acad Emerg Med. 2015;22:182–91.
pubmed: 25641227
doi: 10.1111/acem.12570
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117–25.
pubmed: 18403664
pmcid: 3734893
doi: 10.1378/chest.07-2800
Chetran A, Costache AD, Ciongradi CI, Duca ST, Mitu O, Sorodoc V, et al. ECG and Biomarker Profile in patients with Acute Heart failure: a pilot study. Diagnostics (Basel). 2022;12:3037.
pubmed: 36553044
doi: 10.3390/diagnostics12123037
Szabó GV, Szigetváry C, Szabó L, Dembrovszky F, Rottler M, Ocskay K et al. Point-of-care ultrasound improves clinical outcomes in patients with acute onset dyspnea: a systematic review and meta-analysis. Intern Emerg Med. 2022.
Maisel A. B-type natriuretic peptide measurements in diagnosing congestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med. 2002;3(Suppl 4):S10–17.
pubmed: 12439426
van Kimmenade RRJ, Januzzi JL, Bakker JA, Houben AJ, Rennenberg R, Kroon AA, et al. Renal clearance of B-Type natriuretic peptide and amino terminal Pro-B-Type natriuretic peptide: a mechanistic study in hypertensive subjects. J Am Coll Cardiol. 2009;53:884–90.
pubmed: 19264247
doi: 10.1016/j.jacc.2008.11.032
Levitt JE, Vinayak AG, Gehlbach BK, Pohlman A, Van Cleve W, Hall JB, et al. Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study. Crit Care. 2008;12:R3.
pubmed: 18194554
pmcid: 2374600
doi: 10.1186/cc6764
Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat P-V, Chavelas C, et al. Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol. 2002;40:1794–800.
pubmed: 12446063
doi: 10.1016/S0735-1097(02)02482-8
Ingbar DH. Cardiogenic pulmonary edema: mechanisms and treatment - an intensivist’s view. Curr Opin Crit Care. 2019;25:371.
pubmed: 31116110
doi: 10.1097/MCC.0000000000000626
Figueras J, Weil MH. Blood volume prior to and following treatment of acute cardiogenic pulmonary edema. Circulation. 1978;57:349–55.
pubmed: 618625
doi: 10.1161/01.CIR.57.2.349
Henning RJ, Weil MH. Effect of afterload reduction on plasma volume during acute heart failure. Am J Cardiol. 1978;42:823–7.
pubmed: 707295
doi: 10.1016/0002-9149(78)90103-0
Anguel N, Monnet X, Osman D, Castelain V, Richard C, Teboul J-L. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med. 2008;34:1231–8.
pubmed: 18297263
doi: 10.1007/s00134-008-1038-3
Dres M, Teboul J-L, Anguel N, Guerin L, Richard C, Monnet X. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med. 2014;42:1882–9.
pubmed: 24717458
doi: 10.1097/CCM.0000000000000295
Ferré A, Guillot M, Lichtenstein D, Mezière G, Richard C, Teboul J-L et al. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med. 2019.
Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inf. 2014;48:193–204.
doi: 10.1016/j.jbi.2014.02.013
R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing. 2015. https://www.R-project.org/
Chang W, Cheng J, Allaire JJ, Xie Y, McPherson J. shiny: Web Application Framework for R [Internet]. 2020. https://CRAN.R-project.org/package=shiny
Komiya K, Ishii H, Murakami J, Yamamoto H, Okada F, Satoh K, et al. Comparison of chest computed tomography features in the acute phase of cardiogenic pulmonary edema and acute respiratory distress syndrome on arrival at the emergency department. J Thorac Imaging. 2013;28:322–8.
pubmed: 23615573
doi: 10.1097/RTI.0b013e31828d40b2
Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.
pubmed: 18442425
pmcid: 2386861
doi: 10.1186/1476-7120-6-16
Mahdyoon H, Klein R, Eyler W, Lakier JB, Chakko SC, Gheorghiade M. Radiographic pulmonary congestion in end-stage congestive heart failure. Am J Cardiol. 1989;63:625–7.
pubmed: 2919567
doi: 10.1016/0002-9149(89)90912-0
Collins SP, Lindsell CJ, Storrow AB, Abraham WT, ADHERE Scientific Advisory Committee, Investigators and Study Group. Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med. 2006;47:13–8.
pubmed: 16387212
doi: 10.1016/j.annemergmed.2005.04.003
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1441–6.
pubmed: 5122894
doi: 10.1056/NEJM197112232852601
Marantz PR, Tobin JN, Wassertheil-Smoller S, Steingart RM, Wexler JP, Budner N, et al. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation. 1988;77:607–12.
pubmed: 3342491
doi: 10.1161/01.CIR.77.3.607
Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol. 1992;20:301–6.
pubmed: 1634664
doi: 10.1016/0735-1097(92)90094-4
Remes J, Miettinen H, Reunanen A, Pyörälä K. Validity of clinical diagnosis of heart failure in primary health care. Eur Heart J. 1991;12:315–21.
pubmed: 2040313
doi: 10.1093/oxfordjournals.eurheartj.a059896
Fonseca C, Oliveira AG, Mota T, Matias F, Morais H, Costa C, et al. Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care. Eur J Heart Fail. 2004;6:813–20.
pubmed: 15542422
doi: 10.1016/j.ejheart.2004.08.003
Collins S, Storrow AB, Kirk JD, Pang PS, Diercks DB, Gheorghiade M. Beyond pulmonary edema: diagnostic, risk stratification, and treatment challenges of acute heart failure management in the emergency department. Ann Emerg Med. 2008;51:45–57.
pubmed: 17868954
doi: 10.1016/j.annemergmed.2007.07.007
Laher AE, Watermeyer MJ, Buchanan SK, Dippenaar N, Simo NCT, Motara F, et al. A review of hemodynamic monitoring techniques, methods and devices for the emergency physician. Am J Emerg Med. 2017;35:1335–47.
pubmed: 28366285
doi: 10.1016/j.ajem.2017.03.036
Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009;37:1696–701.
pubmed: 19325473
doi: 10.1097/CCM.0b013e31819f13d0
Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347:161–7.
pubmed: 12124404
doi: 10.1056/NEJMoa020233
Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004;350:647–54.
pubmed: 14960741
doi: 10.1056/NEJMoa031681
van der Burg-de Graauw N, Cobbaert CM, Middelhoff CJFM, Bantje TA, van Guldener C. The additive value of N-terminal pro-B-type natriuretic peptide testing at the emergency department in patients with acute dyspnoea. Eur J Intern Med. 2009;20:301–6.
pubmed: 19393498
doi: 10.1016/j.ejim.2008.09.022
Schwam E. B-type natriuretic peptide for diagnosis of heart failure in emergency department patients: a critical appraisal. Acad Emerg Med. 2004;11:686–91.
pubmed: 15175210
doi: 10.1111/j.1553-2712.2004.tb00725.x
McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing not properly (BNP) multinational study. Circulation. 2002;106:416–22.
pubmed: 12135939
doi: 10.1161/01.CIR.0000025242.79963.4C
Chircop R, Jelinek GA. B-type natriuretic peptide in the diagnosis of heart failure in the emergency department. Emerg Med Australas. 2006;18:170–9.
pubmed: 16669943
doi: 10.1111/j.1742-6723.2006.00825.x
Chenevier-Gobeaux C, Claessens Y-E, Voyer S, Desmoulins D, Ekindjian OGJ-C. Influence of renal function on N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients admitted for dyspnoea in the Emergency Department: comparison with brain natriuretic peptide (BNP). Clin Chim Acta. 2005;361:167–75.
pubmed: 15993397
doi: 10.1016/j.cccn.2005.05.021
Liu J, Shen F, Teboul J-L, Anguel N, Beurton A, Bezaz N, et al. Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal. Crit Care. 2016;20:369.
pubmed: 27836002
pmcid: 5106814
doi: 10.1186/s13054-016-1533-9
Almufleh A, Desai AS, Fay R, Ferreira JP, Buckley LF, Mehra MR, et al. Correlation of laboratory haemoconcentration measures with filling pressures obtained via pulmonary arterial pressure sensors in ambulatory heart failure patients. Eur J Heart Fail. 2020;22:1907–11.
pubmed: 32353199
doi: 10.1002/ejhf.1848
Konishi M, Matsuzawa Y, Suzuki H, Akiyama E, Iwahashi N, Maejima N, et al. Higher level at admission and subsequent decline in hemoglobin in patients with acute pulmonary edema. Circ J. 2014;78:896–902.
pubmed: 24476842
doi: 10.1253/circj.CJ-13-1163
Fujita T, Inomata T, Yazaki M, Iida Y, Kaida T, Ikeda Y, et al. Hemodilution after initial treatment in patients with Acute Decompensated Heart failure. Int Heart J. 2018;59:573–9.
pubmed: 29743416
doi: 10.1536/ihj.17-307