High-Dose Loop Diuretic Can Raise Post-Cardiac Surgery Mortality

The study covered in this summary was published on ResearchSquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

High-dose furosemide after cardiac surgery is associated with increased mortality and other adverse outcomes.

Why This Matters

The influence of furosemide on prognosis after cardiac surgery is not fully understood.
The current findings suggest that high-dose furosemide after cardiac surgery is associated with increased risk for death and other adverse events and therefore should be used cautiously in that setting.

Study Design

The retrospective cohort of 6752 cardiac surgery patients was divided into two groups according to average daily furosemide dosage after cardiac surgery: < 20 mg (low-dose group, n = 6033) and ≥ 20 mg (high-dose group, n = 719).
The group were compared for total furosemide dose, total furosemide dose ≥ 200 mg, total dose of furosemide by patient weight, and average daily furosemide dose ≥ 20 mg.
The primary outcomes were in-hospital mortality and mortality at 1 year after cardiac surgery. Secondary outcomes were length of hospital stay ≥ 14 days, length of intensive care unit (ICU) stay ≥ 3 days, and mechanical ventilation ≥ 48 hours.
The study excluded patients aged younger than 18 whose weight data was missing or who had more than 5% of their data missing.

Key Results

Patients in the high-dose furosemide group tended to be older and have a higher body mass index (BMI) and higher rates of diabetes, chronic pulmonary diseases, heart failure, renal failure, blood transfusion, vasopressor use, and valvular surgery.
They also tended have higher white cell counts and higher levels of blood urea nitrogen, creatinine, glucose, and lactate.
Those in the high-dose group also were on vasopressors and ventilatory support longer.
In adjusted multivariate analysis, increased in-hospital mortality was associated with average daily furosemide dose, average daily dose ≥ 20 mg/d, and total dose ≥ 200 mg.
Increased mortality at 1 year was associated with total furosemide dose and average daily furosemide dose.
Significant multivariate predictors of hospital stay ≥ 14 days, length of ICU stay ≥ 3 days, and mechanical ventilation ≥ 48 hours after cardiac surgery included total furosemide dose, total dose by weight, average daily furosemide dose ≥ 20 mg/d, and total dose ≥ 200 mg.
In subgroup analyses, average daily furosemide dose ≥ 20 mg/d significantly increased risk for in-hospital mortality among patients younger than 60 years or with BMI ≥ 28 who received vasopressors or blood transfusions, those with renal failure, and those with heart failure not involving congestion.

Limitations

No limitations were discussed.

Disclosures

The study was supported by grants from the National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Jiangsu Postdoctoral Science Foundation.
The authors declare that they have no competing interests.

This is a summary of a preprint research study, "Association between furosemide administration and outcomes in patients undergoing cardiac surgery," from Jinghang Li, First Affiliated Hospital of Nanjing Medical University, and colleagues on published on ResearchSquare.com and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on ResearchSquare.com.

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