External validation of the natriuretic response prediction equation to discriminate diuretic response in heart failure.

IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
ESC Heart Failure Pub Date : 2025-02-01 Epub Date: 2024-08-12 DOI:10.1002/ehf2.14801
Patricia Ramírez-Sánchez, Alberto Falcón-Aguirre, Antonio Tepayotl-Aponte, Genaro H Mendoza-Zavala, Luis Olmos-Dominguez, Adolfo Chavez-Mendoza, José A Magaña-Serrano, José A Cigarroa-López, Moises Aceves-Garcia, Jorge Rayo-Chavez, Marcos J Olalde-Roman, Cristina Revilla-Monsalve, Eduardo Almeida-Gutierrez, Jonathan S Chavez-Iñiguez, Edith L Posada-Martinez, Juan B Ivey-Miranda
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引用次数: 0

Abstract

Aims: Incomplete decongestion due to lack of titration of diuretics to effective doses is a common reason for readmission in patients with acute decompensated heart failure (ADHF). The natriuretic response prediction equation (NRPE) is a novel tool that proved to be rapid and accurate to predict natriuretic response and does not need urine collection. However, the NRPE has not been externally validated. The goal of this study was to externally validate the discrimination capacity of the NRPE in patients with ADHF and fluid overload.

Methods and results: Patients admitted with ADHF who required intravenous loop diuretics were included. A spot urine sample was obtained ~2 h following diuretic administration, and a timed 6-h urine collection by study staff was carried out. Urine sodium and urine creatinine from the spot urine sample were used to predict the 6-h natriuretic response using the NRPE. The primary goal was to validate the NRPE to discriminate poor loop diuretic natriuretic response (sodium output <50 mmol in the 6 h following diuretic administration). The NRPE was compared with urine sodium and measured urine output which are the methods currently recommended by international guidelines to assess diuretic response. Eighty-seven diuretic administrations from 49 patients were analysed. Mean age of patients was 57 ± 17 years and 67% were male. Mean estimated glomerular filtration rate was 65 ± 28 mL/min/1.73 m2, and ejection fraction was 35 ± 15%. Median dose of intravenous furosemide equivalents administered the day of the study was 80 mg (IQR 40 - 160). Poor natriuretic response occurred in 39% of the visits. The AUC of the NRPE to predict poor natriuretic response during the 6-h urine collection was 0.91 (95% CI 0.85-0.98). Compared with the NRPE, spot urine sodium concentration (AUC 0.75) and urine output during the corresponding nursing shift (AUC 0.74) showed lower discrimination capacity.

Conclusions: In this cohort of patients with ADHF, the NRPE outperformed spot urine sodium concentration and all other metrics related to diuretic response to predict poor natriuretic response. Our findings support the use of this equation at other settings to allow rapid and accurate prediction of natriuretic response.

用于区分心力衰竭患者利尿剂反应的钠尿肽反应预测方程的外部验证。
目的:急性失代偿性心力衰竭(ADHF)患者再入院的一个常见原因是利尿剂未滴定到有效剂量,导致去充血不完全。钠尿肽反应预测方程(NRPE)是一种新型工具,经证实可快速、准确地预测钠尿肽反应,且无需收集尿液。然而,NRPE 尚未经过外部验证。本研究旨在从外部验证 NRPE 对 ADHF 和液体超负荷患者的分辨能力:纳入需要静脉注射襻利尿剂的 ADHF 患者。在服用利尿剂后约 2 小时采集定点尿样,并由研究人员进行 6 小时定时尿液采集。定点尿样中的尿钠和尿肌酐用于使用 NRPE 预测 6 小时的利尿反应。主要目的是验证 NRPE 对不良襻利尿剂利尿反应的判别能力(钠排出量为 2,射血分数为 35 ± 15%)。研究当天静脉注射的呋塞米当量中位剂量为 80 毫克(IQR 40 - 160)。39%的就诊者钠尿肽反应不佳。在收集 6 小时尿液期间,NRPE 预测不良钠尿酸反应的 AUC 为 0.91(95% CI 0.85-0.98)。与 NRPE 相比,定点尿钠浓度(AUC 0.75)和相应护理班次期间的尿量(AUC 0.74)显示出较低的辨别能力:结论:在这组 ADHF 患者中,NRPE 在预测不良利尿剂反应方面优于定点尿钠浓度和所有其他与利尿剂反应相关的指标。我们的研究结果支持在其他情况下使用该方程快速准确地预测钠尿肽反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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