Usefulness of natriuresis to predict in-hospital diuretic resistance.
Diuretic resistance
heart failure
natriuresis
Journal
American journal of cardiovascular disease
ISSN: 2160-200X
Titre abrégé: Am J Cardiovasc Dis
Pays: United States
ID NLM: 101569582
Informations de publication
Date de publication:
2020
2020
Historique:
received:
24
05
2020
accepted:
06
09
2020
entrez:
23
11
2020
pubmed:
24
11
2020
medline:
24
11
2020
Statut:
epublish
Résumé
Urinary sodium excretion predicts long-term adverse events after discharge in patients with acute heart failure (AHF). The role of natriuresis as an early marker of poor diuretic response during an AHF episode has been scarcely investigated. We sought to evaluate whether early natriuresis or its change during heart failure hospitalization is associated with the development of in-hospital diuretic resistance (DR). This was a prospective, observational single center study of consecutive patients with AHF. Urine electrolytes were estimated from a spot urine sample within the first 6 hours following the first diuretic dose and 48 hours after admission. In-hospital DR was defined as poor diuretic response based on diuretic efficiency metrics and persistent congestion despite an intensive diuretic protocol. Between January and December 2018, 143 patients were admitted for AHF. Of these, 102 fulfilled the inclusion criteria (60% males, median age 77 years [interquartile range [IQR]: 69-83), and 20 patients (19.6%) met the definition of DR. Early natriuresis was lower in patients with DR than in non-resistant patients (46 mEq/L [IQR: 38.5-80.0] vs 97.5 mEq/L [IQR: 70.5-113.5], P<0.001). Urinary sodium <50 mEq/L increased the risk of developing in-hospital DR (risk ratio: 5.011 [95% confidence interval 2.408-10.429], P<0.001). The area under the receiver operating characteristic curve for early natriuresis to predict DR was 0.791 (95% confidence interval 0.681-0.902, P<0.001). Initial natriuresis can predict in-hospital DR. Patients with urinary sodium <50 mEq/L have an increased risk of early resistance to diuretic treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Urinary sodium excretion predicts long-term adverse events after discharge in patients with acute heart failure (AHF). The role of natriuresis as an early marker of poor diuretic response during an AHF episode has been scarcely investigated. We sought to evaluate whether early natriuresis or its change during heart failure hospitalization is associated with the development of in-hospital diuretic resistance (DR).
METHODS
METHODS
This was a prospective, observational single center study of consecutive patients with AHF. Urine electrolytes were estimated from a spot urine sample within the first 6 hours following the first diuretic dose and 48 hours after admission. In-hospital DR was defined as poor diuretic response based on diuretic efficiency metrics and persistent congestion despite an intensive diuretic protocol.
RESULTS
RESULTS
Between January and December 2018, 143 patients were admitted for AHF. Of these, 102 fulfilled the inclusion criteria (60% males, median age 77 years [interquartile range [IQR]: 69-83), and 20 patients (19.6%) met the definition of DR. Early natriuresis was lower in patients with DR than in non-resistant patients (46 mEq/L [IQR: 38.5-80.0] vs 97.5 mEq/L [IQR: 70.5-113.5], P<0.001). Urinary sodium <50 mEq/L increased the risk of developing in-hospital DR (risk ratio: 5.011 [95% confidence interval 2.408-10.429], P<0.001). The area under the receiver operating characteristic curve for early natriuresis to predict DR was 0.791 (95% confidence interval 0.681-0.902, P<0.001).
CONCLUSIONS
CONCLUSIONS
Initial natriuresis can predict in-hospital DR. Patients with urinary sodium <50 mEq/L have an increased risk of early resistance to diuretic treatment.
Types de publication
Journal Article
Langues
eng
Pagination
350-355Informations de copyright
AJCD Copyright © 2020.
Déclaration de conflit d'intérêts
None.
Références
Circ Heart Fail. 2014 Sep;7(5):766-72
pubmed: 25037309
Circ Heart Fail. 2014 Mar 1;7(2):261-70
pubmed: 24379278
Am Heart J. 2018 Sep;203:95-100
pubmed: 29907406
Eur Heart J. 2017 Jun 21;38(24):1872-1882
pubmed: 28329085
JACC Heart Fail. 2019 May;7(5):383-391
pubmed: 31047017
Eur J Heart Fail. 2019 May;21(5):624-633
pubmed: 30773755
N Engl J Med. 2012 Dec 13;367(24):2296-304
pubmed: 23131078
JACC Heart Fail. 2019 May;7(5):404-414
pubmed: 31047021
Eur Heart J. 2013 Mar;34(11):835-43
pubmed: 23293303
Int J Cardiol. 2018 Mar 1;254:189-194
pubmed: 29407090
ESC Heart Fail. 2019 Feb;6(1):80-88
pubmed: 30295437
Circ Heart Fail. 2012 Jan;5(1):54-62
pubmed: 22167320
Eur J Heart Fail. 2019 Feb;21(2):137-155
pubmed: 30600580
Eur Heart J. 2014 May 14;35(19):1284-93
pubmed: 24585267
Eur J Heart Fail. 2014 Feb;16(2):133-42
pubmed: 24464967
J Card Fail. 2014 Jun;20(6):392-9
pubmed: 24704538
J Card Fail. 2018 Jun;24(6):349-354
pubmed: 29410227
Am Heart J. 2015 Aug;170(2):313-21
pubmed: 26299229
Circ Heart Fail. 2016 Jan;9(1):e002370
pubmed: 26721915
Am Heart J. 2002 Jul;144(1):31-8
pubmed: 12094185
Eur J Heart Fail. 2014 Nov;16(11):1230-40
pubmed: 25287144