Crespo-Aznarez Silvia, Campos-Saenz de Santamaría Amelia, Sánchez-Marteles Marta, Josa-Laorden Claudia, Ruiz-Laiglesia Fernando, Amores-Arriaga Beatriz, Garcés-Horna Vanesa, Tejel-Puisac Ruben, Julián-Ansón María Angel, Giménez-López Ignacio, Pérez-Calvo Juan Ignacio, Rubio-Gracia Jorge
Internal Medicine Department, Hospital Clínico Lozano Blesa, 50009 Zaragoza, Spain.
Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain.
J Clin Med. 2024 Feb 12;13(4):1053. doi: 10.3390/jcm13041053.
Congestion is an essential issue in patients with heart failure (HF). Standard treatments do not usually achieve decongestion, and various strategies have been proposed to guide treatment, such as determination of natriuresis. After starting treatment with loop diuretics, we postulate that initial natriuresis might help treatment titration, decongestion, and improve prognosis.
It was a prospective and observational study. Patients admitted with the diagnosis of HF decompensation were eligible. An assessment of congestion was performed during the first 48 h.
A total of 113 patients were included. A poor diuretic response was observed in 39.8%. After the first 48 h, patients with a greater diuretic response on admission (NaU > 80 mmol/L) showed fewer pulmonary b lines (12 vs. 15; = 0.084), a lower IVC diameter (18 mm vs. 22 mm; = 0.009), and lower IAP figures (11 mmHg vs. 13 mmHg; = 0.041). Survival analysis tests demonstrated significant differences showing a higher proportion of all-cause mortality (ACM) and HF rehospitalization in the poor-diuretic-response group (log-rank test = 0.020).
Up to 40% of the patients presented a poorer diuretic response at baseline, translating into worse outcomes. Patients with an optimal diuretic response showed significantly higher abdominal decongestion at 48 h and a better prognosis regarding ACM and/or HF rehospitalizations.
充血是心力衰竭（HF）患者的一个重要问题。标准治疗通常无法实现去充血，因此人们提出了各种策略来指导治疗，比如测定利钠作用。我们推测，在开始使用袢利尿剂治疗后，初始利钠作用可能有助于调整治疗剂量、实现去充血并改善预后。
这是一项前瞻性观察性研究。确诊为HF失代偿的住院患者符合条件。在最初48小时内对充血情况进行评估。
共纳入113例患者。观察到39.8%的患者利尿反应较差。在最初48小时后，入院时利尿反应较强（尿钠排泄量>80 mmol/L）的患者肺b线较少（12条对15条；P = 0.084），下腔静脉直径较小（18 mm对22 mm；P = 0.009），腹内压数值较低（11 mmHg对13 mmHg；P = 0.041）。生存分析测试显示出显著差异，利尿反应较差组的全因死亡率（ACM）和HF再住院率更高（对数秩检验=0.020）。
高达40%的患者在基线时利尿反应较差，这导致了更差的预后。利尿反应最佳的患者在48小时时腹部去充血明显更显著，在ACM和/或HF再住院方面预后更好。
