Prognostic Significance of Estimated Plasma Volume Status in Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Heart failure (HF) remains a leading cause of global mortality; however, despite treatment advances, improvements in prognosis are limited. Non-invasive estimation of plasma volume status (ePVS) from hemoglobin and hematocrit may enhance prognostic accuracy and management. This meta-analysis investigates the association of ePVS with adverse outcomes in HF patients.<h4>Methods</h4>We searched PubMed, Embase, Cochrane, and Web of Science up to June 8, 2024, using specific keywords. Two independent researchers performed the literature search and data extraction, resolving discrepancies through discussion or a third researcher if necessary. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and synthesized using a random-effects model. Sensitivity and subgroup analyses were conducted to explore heterogeneity.<h4>Results</h4>We included 12 articles with 23,282 patients. The highest ePVS group had increased all-cause mortality (HR: 1.66; 95% CI: 1.14-2.40; I² = 73%) and a higher composite endpoint of mortality or HF re-hospitalization (HR: 1.53; 95% CI: 1.26-1.87; I² = 0%) compared to the lowest group. Per unit increase in ePVS corresponded to HRs of 1.18 for mortality (95% CI: 1.07-1.31; I² = 88%) and 1.21 for mortality or re-hospitalization (95% CI: 1.14-1.29; I² = 43%). Sensitivity analysis confirmed result stability, and subgroup analysis showed persistent heterogeneity.<h4>Conclusions</h4>Elevated ePVS predicts HF mortality and rehospitalization. Prospective validation of ePVS is warranted to assess its potential utility for improving risk stratification in clinical practice.