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Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure

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Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure

dc.contributor.author	Núñez Villota, Julio	es_ES
dc.contributor.author	Núñez, Eduardo	es_ES
dc.contributor.author	Miñana, Gema	es_ES
dc.contributor.author	Bodí Peris, Vicente	es_ES
dc.contributor.author	Fonarow, Gregg C.	es_ES
dc.contributor.author	Bertomeu-González, Vicente	es_ES
dc.contributor.author	Palau, Patricia	es_ES
dc.contributor.author	Merlos Díaz, Pilar	es_ES
dc.contributor.author	Ventura, Silvia	es_ES
dc.contributor.author	Chorro Gascó, Francisco Javier	es_ES
dc.contributor.author	Llàcer Iborra, Pau	es_ES
dc.contributor.author	Sanchis, Juan	es_ES
dc.date.accessioned	2015-06-19T10:21:22Z
dc.date.available	2015-06-19T10:21:22Z
dc.date.issued	2012	es_ES
dc.date.issued	2012	es_ES
dc.identifier.citation	European Journal of Heart Failure Vol. 14 Issue 9: pp. 974-984	es_ES
dc.identifier.uri	http://hdl.handle.net/10550/44572
dc.description.abstract	AimsRecent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood urea nitrogen (BUN), but recent findings have also indicated that diuretics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF).Methods and resultsWe analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72 ± 12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent dose) were interacted to a four-level variable according to CA125 (>35 U/mL) and BUN (above the median), and related to all-cause mortality. At a median follow-up of 21 months, 561 (40.4%) patients died. The use of HDLDs was independently associated with increased mortality [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01–1.50], but this association was not homogeneous across CA125–BUN categories (P for interaction <0.001). In patients with normal CA125, use of HDLDs was associated with high mortality if BUN was above the median (HR 2.29, 95% 1.51–3.46), but not in those with BUN below the median (HR 1.22, 95% CI 0.73–2.04). Conversely, in patients with high CA125, HDLDs showed an association with increased survival if BUN was above the median (HR 0.73, 95% CI 0.55–0.98) but was associated with increased mortality in those with BUN below the median (HR 1.94, 95% CI 1.36–2.76).ConclusionThe risk associated with HDLDs in patients after hospitalization for AHF was dependent on the levels of BUN and CA125. The information provided by these two biomarkers may be helpful in tailoring the dose of loop diuretics at discharge for AHF.	es_ES
dc.subject	Loop diuretics	es_ES
dc.subject	Mortality	es_ES
dc.subject	Acute heart failure	es_ES
dc.subject	Carbohydrate antigen 125	es_ES
dc.subject	Blood urea nitrogen	es_ES
dc.title	Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure	es_ES
dc.type	journal article	es_ES
dc.identifier.doi	10.1093/eurjhf/hfs090	es_ES
dc.identifier.idgrec	088375	es_ES