Details

Autor(en) / Beteiligte

• Su, Ying
• Zhang, Yi-jie
• Tu, Guo-wei
• Hou, Jun-yi
• Ma, Guo-guang
• Hao, Guang-wei
• Xu, Rong-hui
• Luo, Zhe

Titel

Furosemide responsiveness predicts acute kidney injury progression after cardiac surgery

Ist Teil von

• The Annals of thoracic surgery, 2024-02, Vol.117 (2), p.432-438

Ort / Verlag

Netherlands: Elsevier Inc

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• As patients with acute kidney injury (AKI) progress to a higher stage, the risk for poor outcomes dramatically rises. Early identification of patients at high risk for AKI progression remains a major challenge. This study aimed to evaluate the value of furosemide responsiveness (FR) for predicting AKI progression in patients with initial mild and moderate AKI after cardiac surgery. We performed two separate exploratory analyses. The Zhongshan cohort was a single-center, prospective, observational cohort. The MIMIC-Ⅳ cohort was a single-center, retrospective cohort. We calculated two FR parameters for each patient, namely furosemide responsiveness index (FRI) and modified FRI (mFRI), which were defined as 2-h urine output divided by furosemide dose (FRI, mL/mg/2 h) and by furosemide dose and body weight [mFRI, mL/(mg·kg)/2 h], respectively. The primary outcome was AKI progression within 7 days. AKI progression occurred in 80 (16.0%) and 359 (11.3%) patients in the Zhongshan and MIMIC-Ⅳ cohorts, respectively. All FR parameters (considered continuously or in quartiles) were inversely associated with risk of AKI progression in both cohorts (all adjusted P < 0.01). The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models involving C-index, net reclassification improvement and integrated discrimination improvement index in both cohorts (all P < 0.01). FR parameters were inversely associated with risk of AKI progression in patients with mild and moderate AKI after cardiac surgery. The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models.