Background:

In patients with acute decompensated heart failure (ADHF), early evaluation of diuretic efficiency (DE) could predict diuretic response and clinical outcome.

Objectives:

The aim of our study was to evaluate the association of DE with diuretic resistance (DR) in-hospital cardiovascular mortality, and readmission or cardiovascular mortality at 60 days in ADHF.

Methods:

We conducted a multicenter and prospective study of patients hospitalized for ADHF. All patients received 40 mg of furosemide within two hours of admission and 20 mg every 8 hours in the first 24 hours. Subsequent adjustment of diuretic dose was left to the discretion of the investigator as determined by a pre-established protocol. Diuretic efficiency was defined as the ratio of net fluid balance and cumulative amount of furosemide within the first 24 hours. Diuretic resistance was defined as requirement of furosemide infusion ≥240 mg/day during the first 72 hours. The clinical and biochemical variables were evaluated. The primary outcome was a composite of in-hospital cardiovascular mortality, and cardiovascular mortality or readmissions for ADHF at 60 days.

Results:

The cohort was made up of 157 patients; median age was 74 years and 56 % were men. Diuretic efficiency was -15 mL/ mg (interquartile range, IQR, -20 to -11). Diuretic resistance was evident in 13 % of patients, 8 % required sequential diuretic blockade, and 4 % required renal replacement therapy. Worsening renal function occurred in 22 % of patients. Cardiovascular mortality during hospitalization and at 60 days was 5.7 % and 6 %, respectively. Readmission rate for ADHF at 60 days was 12 %. Worse DE value was associated DR (p = 0.013), while patients in DE quartiles above -11 mL/mg were highly unlikely to develop DR (AUC 0.73, negative predictive value, NPV, 92.5 %). Worse DE value was associated with the CEP (p = 0.025), higher in-hospital cardiovascular mortality (p = 0.003), persistent congestion at 48 hours (p = 0.007), higher cumulative dose of furosemide at 72 hours (p = 0.001) worsening ADHF during hospitalization (p = 0.004).

Conclusion:

Low initial DE was associated with DR, persistent congestion, and higher in-hospital cardiovascular mortality in ADHF and constitutes a useful parameter to detect those patients who could benefit from early intensive diuretic treatment.