The influence of cumulative fluid balance on volume status in patients with heart failure: a multicenter cohort study

Abstract Purpose: To explore the influence of cumulative fluid balance (CFB) on volume status in patients with heart failure (HF).Methods: A total of 206 patients were enrolled and divided into groups of decreasing estimated plasma volume status (△ePVS(-)) (n=106) and increasing estimated plasma volume status(△ePVS(+)) (n=100), or groups of alleviated clinical congestion score(△CCS(-)) (n=86) and aggravated clinical congestion score(△CCS(+)) (n=120) according to the change of plasma volume and congestion status respectively. Data on patients’ general information and CFB at 1 to 7 days were compared between two pairs of groups respectively.Results: The incidence of positive CFB ranged from 65.53% to 74.76%, and cumulative volume (CV) were from (0.23±1.00)L to (2.36±5.46)L at 1 to 7 days. CV at 4 to 7 days in the △ePVS(+) and △CCS(+) groups were significantly higher than that in △ePVS(-) and △CCS(-) groups respectively. When CV at 4 to 7 days reached 2.308L, 3.361L, 3.625L, and 3.816L, the AUC of ePVS were 0.672, 0.722, 0.644, and 0.754, respectively (P＜0.05), while when CV reached 2.308L, 3.383L, 4.670L, and 4.622L, the AUC of CCS were 0.625, 0.696, 0.656, and 0.709, separately (P＜0.05). Conclusions: Patients with HF have a high incidence of positive CFB. CV at 4 to 7 days was an independent risk factor for △ePVS(+) and △CCS(+). It is suggested that the duration and volume of positive CFB should not exceed 3 days and 2.308L.