Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation
Abstract
:1. Introduction
2. Methods
2.1. Echocardiography Assessment
2.2. Blood Collection
2.3. Cardiovascular Events
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Conflicts of Interest
References
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Variables | No-Event Group (205 pts) | Event Group (58 pts) | p Value |
---|---|---|---|
Age | 77 (70–82) | 79 (76–85) | 0.01 |
Gender Male (%) | 63 | 64 | 0.88 |
Sodium (MEq/L) | 140 (138–143) | 140 (136–142) | 0.04 |
Creatinine (mg/dL) | 1.06 (0.82–1.45) | 1.53 (1.04–2.05) | <0.001 |
GFR mL/min/1.73 mq | 52 (40–68) | 39 (28–50) | <0.001 |
Hb (gr/L) | 12 (10.5–13.7) | 12.6 (11.2–13.5) | 0.22 |
RDW | 14.8 (13.8–16) | 15.9 (14.7–17.7) | <0.001 |
Pro-BNP (pg/mL) | 5210 (1851–14,901) | 12,922 (7074–27,769) | <0.001 |
LVEF (%) | 47 (35–55) | 38 (26–50) | 0.001 |
LVESD (mm) | 37 (30–46) | 45 (35–57) | 0.008 |
LVEDD (mm) | 51 (46–60) | 59 (48–66) | 0.04 |
TAPSE (mm) | 17 (15–20) | 16 (15–20) | 0.32 |
PASP (mmHg) | 37 (30–45) | 45 (35–58) | 0.003 |
Length of hospital stay (days) | 10 (7–14) | 10 (7–15) | 0.35 |
Baseline body weight (kg) | 73.9 (63–89.3) | 70.9 (56.8–89.9) | 0.30 |
Body weight at Day 4 (kg) | 72.4 (60.4–87.8) | 70.9 (58–87.4) | 0.77 |
Diuresis on Day 4 (mL/die) | 1800 (1300–2600) | 1900 (1400–2800) | 0.44 |
Diuretic dosage on Day 4 (mg/die) | 60 (50–100) | 100 (50–237) | 0.005 |
R-to-D (kg/40 mg furosemide) | 1.74 (1.02–3.48) | 1.53 (0.77–2.49) | 0.03 |
Diuretic response (kg/40 mg furosemide) | 1.50 (0.75–3.20) | 1.29 (0.53–2.17) | 0.02 |
Diabetes mellitus N (%) | 30 | 50 | 0.004 |
Coronary artery disease N (%) | 39 | 33 | 0.38 |
Hypertension (%) | 65 | 81 | 0.03 |
CKD (%) | 66 | 83 | 0.01 |
AF (%) | 34 | 53 | 0.02 |
(A) 180-Day HF Rehospitalization or Death | ||||
Univariate Analysis | Multivariate Analysis 1 | |||
Variable | HR (95% CI) | p Value | HR (95% CI) | p Value |
Q1 R to D (R to D < 0.97 kg/40 mg) | 2.53 (1.11–5.67) | 0.03 | 2.36 (1.02–5.47) | 0.04 |
Q2 R to D (0.97 ≤ R to D < 1.69 kg/40 mg) | 2.09 (0.88–4.93) | 0.09 | 2.52 (1.04–6.10) | 0.04 |
Q3 R to D (1.69 ≤ R to D < 3.28 kg/40 mg) | 2.26 (0.97–5.29) | 0.06 | 2.35 (0.99–5.55) | 0.06 |
Q4 R to D (R to D ≥ 3.28 kg/40 mg) | Reference | Reference | ||
(B) 180-Day HF Rehospitalization or Death | ||||
Q1 DR (DR < 0.67 kg/40 mg) | 2.56 (1.17–5.63) | 0.02 | 2.27 (1.01–5.08) | 0.05 |
Q2 DR (0.67 ≤ DR < 1.44 kg/40 mg) | 1.54 (0.66–3.61) | 0.32 | 1.81 (0.76–4.31) | 0.18 |
Q3 DR (1.44 ≤ DR < 2.80 kg/40 mg) | 2.13 (0.94–4.81) | 0.07 | 2.23 (0.97–5.12) | 0.06 |
Q4 DR (DR ≥ 2.80 kg/40 mg) | Reference | Reference |
Characteristics | All Patients | HFrEF | HFpEF | p Value |
---|---|---|---|---|
n = 263 | n = 146 | n = 117 | ||
Age (years) | 78 (70–83) | 79 (73–83) | 76 (68–82) | 0.03 |
Gender Male (%) | 62 | 71 | 52 | 0.003 |
Comorbidities (%): | ||||
CAD | 38 | 47 | 26 | 0.001 |
Diabetes | 34 | 40 | 27 | 0.04 |
Hypertension | 69 | 62 | 78 | 0.007 |
AF | 38 | 41 | 35 | 0.42 |
CKD | 69 | 74 | 64 | 0.08 |
Laboratory variables | ||||
Creatinine (mg/dL) | 1.13 (0.85–1.61) | 1.28 (0.94–1.89) | 1.02 (0.80–1.25) | <0.001 |
eGFR (mL/min/m2) | 50 (37–66) | 45 (32–61) | 53 (45–73) | <0.001 |
Hemoglobin (g/L) | 12.1 (10.7–13.7) | 12.9 (11.5–14.2) | 11 (10.1–11.9) | <0.001 |
RDW | 14.9 (14–16.4) | 15.3 (14.2–16.5) | 14.6 (13.6–16) | 0.02 |
NTproBNP (pg/mL) | 7851 (2623–17,989) | 10,285 (4027–26,078) | 3880 (1457–10,686) | <0.001 |
Echocardiography: | ||||
EDD (mm) | 53 (46–60) | 60 (51–65) | 48 (41–53) | <0.001 |
ESD (mm) | 39 (31–47) | 46 (39–55) | 32 (28–39) | <0.001 |
PASP (mmHg) | 40 (30–50) | 39 (30–50) | 40 (31–50) | 0.49 |
TAPSE (mm) | 17 (15–20) | 16 (15–20) | 18 (15–20) | 0.31 |
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Feola, M.; Rossi, A.; Testa, M.; Ferreri, C.; Palazzuoli, A.; Pastorini, G.; Ruocco, G. Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation. J. Clin. Med. 2020, 9, 2932. https://doi.org/10.3390/jcm9092932
Feola M, Rossi A, Testa M, Ferreri C, Palazzuoli A, Pastorini G, Ruocco G. Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation. Journal of Clinical Medicine. 2020; 9(9):2932. https://doi.org/10.3390/jcm9092932
Chicago/Turabian StyleFeola, Mauro, Arianna Rossi, Marzia Testa, Cinzia Ferreri, Alberto Palazzuoli, Guido Pastorini, and Gaetano Ruocco. 2020. "Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation" Journal of Clinical Medicine 9, no. 9: 2932. https://doi.org/10.3390/jcm9092932