Abstract 18301: Neurohormonal Activation Status Influences Prognostic Implication of Diuretics in Acute Decompensated Heart Failure

Abstract

Introduction: The high serum levels of blood urea nitrogen (BUN) reflects neurohormonal activation including sympathetic nervous system and rennin-angiotensin-aldosterone system in hear failure patients. Although furosemide is a mainstay for acute decompensated heart failure (ADHF) treatment, there is possibility of worsening prognosis by adversely affecting the pathophysiology of ADHF including neurhormonal activation. Hypothesis: We hypothesize that the prognostic implication of furosemide dose is influenced by the degree of neurohormonal activation in ADHF patients. Methods: A total of 1044 patients with ADHF (78.2±12.7 years, 50.8% males) were included retrospectively from 3 hospitals in Japan, and 85 patients (8.1%) died during hospitalization. Patients were divided into 4 groups according to quartiles of total furosemide equivalent dose which was used within 2 days from admission (median 70.0mg, IQR 40-120mg). Patients were also divided to 2 groups according to median serum BUN value of 23 mg/dl (high-BUN group, n=515 and low-BUN group, n=529). Results: In-hospital mortality was increased as furosemide dose was increased (Q1: 8.4%, Q2: 6.0%, Q3: 11.9%, Q4: 18.0%, P=0.009) in high BUN group, but not in the low BUN group (Q1: 2.3%, Q2: 5.6%, Q3: 2.4%, Q4: 6.0%, P=0.28). Moreover, when Q1 group was used as a reference, odds ratio for in-hospital mortality was increased as the dose was increased even after multivariate analysis in high-BUN group (Q2: OR, 0.83; 95% CI, 0.29-2.73; P=0.82, Q3: OR, 1.99; 95% CI, 0.71-5.58; P=0.19, and Q4: OR, 2.84; 95% CI, 1.15-6.99; P=0.02, respectively) but not in low-BUN group (Q2: OR, 1.93; 95% CI, 0.45-8.22; P=0.37, Q3: OR, 1.14; 95% CI, 0.22-6.02; P=0.88, and Q4: OR, 1.85; 95% CI, 0.42-8.20; P=0.42, respectively). Conclusions: High dose furosemide use in ADHF patients increased in-hospital mortality in high-BUN group but not in low-BUN group. This indicates the influence of neurohormonal state on prognostic implication of furosemide dose used in acute phase of ADHF.