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Prognostic Value of Fractional Excretion of Urea Nitrogen at Discharge in Acute Decompensated Heart Failure.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Aug 17; Vol. 10 (16), pp. e020480. Date of Electronic Publication: 2021 Aug 07. - Publication Year :
- 2021
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Abstract
- Background Maintaining euvolemia is crucial for improving prognosis in acute decompensated heart failure (ADHF). Although fractional excretion of urea nitrogen (FEUN) is used as a body fluid volume index in patients with acute kidney injury, the clinical impact of FEUN in patients with ADHF remains unclear. This study aimed to investigate whether FEUN can determine the long-term prognosis in patients with ADHF. Methods and Results We retrospectively identified 466 patients with ADHF who had FEUN measured at discharge between April 2011 and December 2018. The primary endpoint was post-discharge all-cause death. Patients were divided into two groups according to a FEUN cut-off value of 35%, commonly used in pre-renal failure. The FEUN <35% (low-FEUN) group included 224 patients (48.1%), and the all-cause mortality rate for the total cohort was 37.1%. The log-rank test revealed that the low-FEUN group had a significantly higher rate of all-cause death compared to the FEUN equal to or greater than 35% (high-FEUN) group ( P <0.001). Multivariate Cox proportional hazards model analysis revealed that low-FEUN was associated with post-discharge all-cause death, independently of other heart failure risk factors (hazard ratio, 1.467; 95% CI, 1.030-2.088, P =0.033). The risk of low-FEUN compared to high-FEUN in post-discharge all-cause death was consistent across all subgroups; however, the effects tended to be modified by renal function (threshold: 60 mL/min/1.73 m <superscript>2</superscript> , interaction P =0.069). Conclusions Our study suggests that FEUN may be a novel surrogate marker of volume status in patients with ADHF requiring diuretics.
- Subjects :
- Acute Disease
Aged
Aged, 80 and over
Biomarkers blood
Biomarkers urine
Creatinine blood
Creatinine urine
Disease Progression
Diuretics therapeutic use
Female
Heart Failure diagnosis
Heart Failure drug therapy
Heart Failure mortality
Humans
Male
Patient Readmission
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Urea blood
Urea urine
Blood Urea Nitrogen
Creatinine metabolism
Heart Failure metabolism
Patient Discharge
Urea metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 34369200
- Full Text :
- https://doi.org/10.1161/JAHA.120.020480