Ferreira João Pedro, Girerd Nicolas, Bettencourt Medeiros Pedro, Bento Ricardo Miguel, Almeida Tiago, Rola Alexandre, Zannad Faiez, Rossignol Patrick, Aragão Irene
INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France.
Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
Cardiorenal Med. 2017 Feb;7(2):137-149. doi: 10.1159/000455903. Epub 2017 Jan 21.
The assessment of the amount of urine produced by the dose of administered diuretic has been proposed as the main signal of interest in diuretic responsiveness - diuretic efficiency (DE). The main aim of our study is to determine if a low DE is associated with 180-day all-cause mortality (ACM).
During a 3-year period, we retrospectively studied patients with acutely decompensated heart failure (ADHF) and respiratory insufficiency admitted to the emergency room of a tertiary university hospital in Porto, Portugal. A total of 170 patients (age 76.2 ± 10.3 years) were included. The outcome of ACM occurred in 43 (25.3%) patients during the 180-day follow-up period. DE was evaluated for a maximum of 3 h after emergency room admission. The lowest DE was defined as ≤140 mL of diuresis per 40 mg of furosemide equivalents.
No significant differences in age, comorbidities, baseline HF symptoms, or disease-modifying medication were found between the lowest and highest DE groups. The lowest DE group had higher blood urea and lower estimated glomerular filtration rate (eGFR) levels (41.3 ± 24.5 vs. 56.7 ± 23.2 mL/min/1.73 m, < 0.001). The patients with the lowest DE had significantly higher rates of ACM during the 180-day follow-up, even after adjustment for other clinically relevant variables: hazard ratio (HR) [95% CI] = 2.31 [1.16-4.58], = 0.016. The lowest diuresis (≤300 mL) and the highest intravenous furosemide dose (>80 mg) alone were not significantly associated with the outcome. After adjustment for N-terminal prohormone of brain natriuretic peptide, the association between the lowest DE and the outcome lost strength (HR [95% CI] = 1.53 [0.75-3.13], = 0.240).
A low DE (≤140 mL/40 mg of furosemide) in the first 3 h after an ADHF episode was associated with increased mid-term mortality rates.
通过给予利尿剂剂量所产生的尿量评估，已被提议作为利尿剂反应性——利尿剂效率（DE）的主要关注指标。我们研究的主要目的是确定低DE是否与180天全因死亡率（ACM）相关。
在3年期间，我们对葡萄牙波尔图一家三级大学医院急诊室收治的急性失代偿性心力衰竭（ADHF）和呼吸功能不全患者进行了回顾性研究。共纳入170例患者（年龄76.2±10.3岁）。在180天随访期间，43例（25.3%）患者发生了ACM。在急诊室入院后最多3小时内评估DE。最低DE定义为每40毫克速尿等效物的尿量≤140毫升。
最低和最高DE组在年龄、合并症、基线HF症状或疾病改善药物方面未发现显著差异。最低DE组的血尿素较高，估计肾小球滤过率（eGFR）水平较低（41.3±24.5对56.7±23.2毫升/分钟/1.73平方米，<0.001）。即使在对其他临床相关变量进行调整后，最低DE的患者在180天随访期间的ACM发生率仍显著较高：风险比（HR）[95%置信区间]=2.31[1.16 - 4.58]，=0.016。仅最低尿量（≤300毫升）和最高静脉速尿剂量（>80毫克）与结局无显著关联。在对脑钠肽前体N末端进行调整后，最低DE与结局之间的关联强度减弱（HR[95%置信区间]=1.53[0.75 - 3.13]，=0.240）。
ADHF发作后最初3小时内低DE（≤140毫升/40毫克速尿）与中期死亡率增加相关。
