急性失代偿性心力衰竭患者首次利尿剂剂量时尿量充足对住院时间的影响

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-05-24 DOI:10.1016/j.hrtlng.2025.05.009

Gagan Gupta MD , Adam Stein MD , Matthew Konerman MD , Nicole Farquhar MEng , Sarah Adie PharmD, BCCP

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引用次数: 0

摘要

背景：静脉利尿剂是急性失代偿性心力衰竭（ADHF）患者的主要治疗方法之一。虽然目前的指南建议静脉利尿的利尿剂剂量至少为每日家庭利尿剂剂量的2.5倍，但没有文献评估首次剂量达到利尿阈值的患者的结果。目的评价首次静脉利尿剂剂量与足量尿量（UOP）及留置时间（LOS）的关系。方法本研究为单中心回顾性研究，纳入密歇根大学ADHF住院患者（205/05 - 2024 11/11）。患者在住院第一天内服用利尿剂，并在给药后3小时、6小时、12小时和24小时追踪其UOP。适当的UOP被定义为利尿剂给药后3小时平均150毫升/小时。研究的主要结局是LOS。次要终点包括6、12、24小时和30天再入院时的尿量。结果共纳入988例患者。547例患者UOP充足，441例患者UOP不足。UOP充足患者的中位LOS为5.20（3.26-8.51）天，而UOP不足患者的中位LOS为5.93（3.73-9.72）天（p = 0.007）。UOP充足的队列在间隔6、12和24小时时有较高的UOP量。在充分和不充分的UOP队列中，30天再入院率没有观察到差异（17.0% vs 17.6%, p = 0.445）。结论具有足够UOP的ADHF患者的LOS明显缩短。

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The effect of adequate urinary output to the first diuretic dose on length of stay in patients hospitalized for acute decompensated heart failure

Background

Intravenous (IV) diuretic use is one of the mainstays of therapy for patients admitted with acute decompensated heart failure (ADHF). While current guidelines recommend administration of at least 2.5 times the daily home diuretic dose for IV diuresis, there is no literature evaluating outcomes for patients reaching their diuretic threshold on their first dose.

Objective

This study aimed to evaluate adequate urinary output (UOP) to first IV diuretic dose and length of stay (LOS).

Methods

This single center retrospective study included patients admitted to the University of Michigan for ADHF (05/2023–11/2024). Patients received diuretics within their first day of hospitalization and their UOP was tracked at 3-, 6-, 12-, and 24-hours post administration. Adequate UOP was defined as an average of >150 mL/hr 3-hours post diuretic administration. The primary outcome studied was LOS. Secondary endpoints included urinary output volume at 6-, 12-, and 24-hours and 30-day readmission.

Results

A total of 988 patients were included. There were 547 patients with adequate UOP and 441 patients with inadequate UOP. Patients with adequate UOP had a median LOS of 5.20 (3.26–8.51) days while patients with inadequate UOP had a median LOS of 5.93 (3.73–9.72) days (p = 0.007). The adequate UOP cohort had higher volumes of UOP at the interval 6-, 12-, and 24-hour marks. There were no observed differences in 30-day readmissions between the adequate and inadequate UOP cohorts (17.0 % vs 17.6 %, p = 0.445).

Conclusion

Patients admitted for ADHF who had an adequate UOP had a significantly shorter LOS.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.