Renal function on admission modifies prognostic impact of diuretics in acute heart failure: a propensity score matched and interaction analysis
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- 作者：Yuya Matsue ; Atsushi Shiraishi ; Nobuyuki Kagiyama ; Kazuki Yoshida…
- 关键词：Acute heart failure ; Diuretics ; Renal function ; Prognosis
- 刊名：Heart and Vessels
- 出版年：2016
- 出版时间：December 2016
- 年：2016
- 卷：31
- 期：12
- 页码：1980-1987
- 全文大小：
- 刊物类别：Medicine
- 刊物主题：Cardiology; Cardiac Surgery; Vascular Surgery; Biomedical Engineering;
- 出版者：Springer Japan
- ISSN：1615-2573
- 卷排序：31
文摘
Although intravenous diuretics have been mainstay drugs in patients with acute heart failure (AHF), they have been suggested to have some deleterious effects on prognosis. We postulated that renal function may modify their deleterious effects in AHF patients. The study population consisted of 1094 AHF patients from three hospitals. Renal dysfunction (RD) was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on admission, and the cohort was divided into a high-dose furosemide (≥100 mg/48 h) and low-dose furosemide group according to the amount of intravenous furosemide used within 48 h from admission. In the whole cohort, in-hospital mortality rate was higher in the high-dose furosemide group than the low-dose furosemide group (12.5 vs. 6.6 %, respectively, P = 0.001). However, this difference in the in-hospital mortality rates was significant only in the RD subgroup (15.6 vs. 7.0 %, respectively, P < 0.001), and not in the non-RD subgroup (2.5 vs. 5.9 %, respectively, P = 0.384). Propensity score-matched analysis was performed to evaluate the impact of high-dose furosemide on prognosis. After propensity score matching, high-dose furosemide was not associated with in-hospital mortality (OR 1.25, 95 % CI 0.73–2.16, P = 0.408). However, there was a qualitative difference in OR for in-hospital mortality between AHF with RD (OR 1.77, 95 % CI 0.96–3.28, P = 0.068) and without RD (OR 0.23, 95 % CI 0.05–1.10, P = 0.064), and there was a significant interaction between eGFR and prognostic impact of high-dose furosemide (P for OR interaction = 0.013). An inverse relationship was observed between eGFR and OR for in-hospital death in the group treated with high-dose furosemide (decreasing OR with better eGFR). The deleterious effect of diuretics was significantly modified with renal function in AHF. This association may be one reason for poorer prognosis of AHF patients complicated with renal impairment.