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Diuretic Responsiveness and its Prognostic Significance in Children with Heart Failure.

J Card Fail. 2019 Apr 12;:

Authors: Price JF, Younan S, Cabrera AG, Denfield SW, Tunuguntla H, Choudhry S, Dreyer WJ, Akcan-Arikan A

Abstract
BACKGROUND: Loop diuretics are considered first-line therapy for congestion in children with heart failure, though some patients remain volume overloaded during treatment. We sought to characterize loop diuretic responsiveness (DR) in children hospitalized with acute decompensated failure (ADHF) and to determine whether a decreased response was associated with worse outcomes.
METHODS AND RESULTS: DR was calculated for 108 consecutive children ˂21 years of age who were hospitalized with ADHF. DR was defined as net fluid (mL) output per 1mg of furosemide equivalents during the first 72 hours of treatment with a loop diuretic. The primary outcome was the composite end-point of inpatient death or use of mechanical circulatory support. Median DR was 6.0 ml/mg (IQR -2.4 to 15.7 ml/mg). Thirty-two percent of patients remained in a positive fluid balance after 72 hours of treatment with a loop diuretic. Death or use of mechanical circulatory support occurred in 29 (27%) patients. Low DR was associated with the composite end-point, even after adjusting for net urine output and loop diuretic dose indexed to weight (OR 5.3, p=0.003). Patients with low DR also experienced longer length of hospital stay than patients with greater DR (median, 33 vs 11 days, p=0.002).
CONCLUSION: In children hospitalized with ADHF, early diminished loop DR during decongestion therapy is common and portends a poor prognosis.

PMID: 30986498 [PubMed – as supplied by publisher]

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