EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal.
EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
J Card Fail. 2017 Aug;23(8):589-593. doi: 10.1016/j.cardfail.2017.04.001. Epub 2017 Apr 5.
High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients.
A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively).
In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.
慢性心力衰竭（HF）中高剂量利尿剂可能有害。我们评估了动态呋塞米剂量对 HF 门诊患者全因死亡率的影响。
从专门治疗 HF 的门诊诊所中回顾性随访了 560 名门诊患者的队列，中位年龄为 70 岁，67%为男性，89%为中重度射血分数降低，随访时间长达 5 年。将动态呋塞米暴露分为低（0-59mg/d）、中（60-119mg/d）、高（120-159mg/d）和极高（≥160mg/d）剂量。使用扩展 Cox 模型估计利尿剂剂量随时间变化与死亡率之间的关系。呋塞米剂量较高与死亡之间存在剂量依赖性的粗关联（危险比 [HR] = 1.34，95%置信区间 [CI]：1.06-2.16；HR = 2.09，95% CI：1.54-2.84，分别用于高剂量和极高剂量），这完全可以用患者特征和疾病严重程度指标来解释（调整 HR = 0.94，95% CI：0.63-1.38；HR = 1.10，95% CI：0.79-1.55，分别用于高剂量和极高剂量）。
在这种情况下，更高剂量的利尿剂并未损害生存率，反而表明患者病情更严重。
