Effect of high-dose furosemide on the prognosis of critically ill patients

Seok Jeong Lee, Chong Whan Kim, Myoung Kyu Lee, Sangha Kim, Suk Joong Yong, Won Yeon Lee

Research output: Contribution to journalArticle

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Abstract

Purpose Diuretics are used frequently in critically ill patients. We investigated the effects of furosemide on the prognosis. Materials and methods Following a retrospective review of patients admitted to the medical intensive care unit (ICU), we analyzed risk factors with variables including initial furosemide dose for ICU mortality. Results A total of 448 patients were included. Total furosemide dose during the first three days of the ICU stay (odds ratio (OR) 2.35, 95% confidence interval (CI) 1.01–5.02) and fluid balance during the same period (OR 3.04, 95% CI 1.46–6.31) were associated with ICU mortality, as were malignancy, chronic furosemide use, and APACHE II score. However, in oliguric patients, positive fluid balance was associated with ICU mortality (OR 22.33, 95% CI 1.82–273.72) but the high-dose furosemide was not. In contrast, in non-oliguric patients, high-dose furosemide was associated with ICU mortality (OR 2.47, 95% CI 1.01–5.68); however, the positive fluid balance showed only a trend for high ICU mortality. Conclusion Early high-dose furosemide use is associated with ICU mortality, particularly in non-oliguric patients. We suggest that furosemide should be used with caution even in non-oliguric critically ill patients until the safety is confirmed in powered study.

Original languageEnglish
Pages (from-to)36-41
Number of pages6
JournalJournal of Critical Care
Volume41
DOIs
Publication statusPublished - 2017 Oct 1

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Furosemide
Critical Illness
Intensive Care Units
Water-Electrolyte Balance
Mortality
Odds Ratio
Confidence Intervals
APACHE
Patient Safety
Diuretics

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Lee, Seok Jeong ; Kim, Chong Whan ; Lee, Myoung Kyu ; Kim, Sangha ; Yong, Suk Joong ; Lee, Won Yeon. / Effect of high-dose furosemide on the prognosis of critically ill patients. In: Journal of Critical Care. 2017 ; Vol. 41. pp. 36-41.
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abstract = "Purpose Diuretics are used frequently in critically ill patients. We investigated the effects of furosemide on the prognosis. Materials and methods Following a retrospective review of patients admitted to the medical intensive care unit (ICU), we analyzed risk factors with variables including initial furosemide dose for ICU mortality. Results A total of 448 patients were included. Total furosemide dose during the first three days of the ICU stay (odds ratio (OR) 2.35, 95{\%} confidence interval (CI) 1.01–5.02) and fluid balance during the same period (OR 3.04, 95{\%} CI 1.46–6.31) were associated with ICU mortality, as were malignancy, chronic furosemide use, and APACHE II score. However, in oliguric patients, positive fluid balance was associated with ICU mortality (OR 22.33, 95{\%} CI 1.82–273.72) but the high-dose furosemide was not. In contrast, in non-oliguric patients, high-dose furosemide was associated with ICU mortality (OR 2.47, 95{\%} CI 1.01–5.68); however, the positive fluid balance showed only a trend for high ICU mortality. Conclusion Early high-dose furosemide use is associated with ICU mortality, particularly in non-oliguric patients. We suggest that furosemide should be used with caution even in non-oliguric critically ill patients until the safety is confirmed in powered study.",
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Effect of high-dose furosemide on the prognosis of critically ill patients. / Lee, Seok Jeong; Kim, Chong Whan; Lee, Myoung Kyu; Kim, Sangha; Yong, Suk Joong; Lee, Won Yeon.

In: Journal of Critical Care, Vol. 41, 01.10.2017, p. 36-41.

Research output: Contribution to journalArticle

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AU - Lee, Seok Jeong

AU - Kim, Chong Whan

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AU - Yong, Suk Joong

AU - Lee, Won Yeon

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N2 - Purpose Diuretics are used frequently in critically ill patients. We investigated the effects of furosemide on the prognosis. Materials and methods Following a retrospective review of patients admitted to the medical intensive care unit (ICU), we analyzed risk factors with variables including initial furosemide dose for ICU mortality. Results A total of 448 patients were included. Total furosemide dose during the first three days of the ICU stay (odds ratio (OR) 2.35, 95% confidence interval (CI) 1.01–5.02) and fluid balance during the same period (OR 3.04, 95% CI 1.46–6.31) were associated with ICU mortality, as were malignancy, chronic furosemide use, and APACHE II score. However, in oliguric patients, positive fluid balance was associated with ICU mortality (OR 22.33, 95% CI 1.82–273.72) but the high-dose furosemide was not. In contrast, in non-oliguric patients, high-dose furosemide was associated with ICU mortality (OR 2.47, 95% CI 1.01–5.68); however, the positive fluid balance showed only a trend for high ICU mortality. Conclusion Early high-dose furosemide use is associated with ICU mortality, particularly in non-oliguric patients. We suggest that furosemide should be used with caution even in non-oliguric critically ill patients until the safety is confirmed in powered study.

AB - Purpose Diuretics are used frequently in critically ill patients. We investigated the effects of furosemide on the prognosis. Materials and methods Following a retrospective review of patients admitted to the medical intensive care unit (ICU), we analyzed risk factors with variables including initial furosemide dose for ICU mortality. Results A total of 448 patients were included. Total furosemide dose during the first three days of the ICU stay (odds ratio (OR) 2.35, 95% confidence interval (CI) 1.01–5.02) and fluid balance during the same period (OR 3.04, 95% CI 1.46–6.31) were associated with ICU mortality, as were malignancy, chronic furosemide use, and APACHE II score. However, in oliguric patients, positive fluid balance was associated with ICU mortality (OR 22.33, 95% CI 1.82–273.72) but the high-dose furosemide was not. In contrast, in non-oliguric patients, high-dose furosemide was associated with ICU mortality (OR 2.47, 95% CI 1.01–5.68); however, the positive fluid balance showed only a trend for high ICU mortality. Conclusion Early high-dose furosemide use is associated with ICU mortality, particularly in non-oliguric patients. We suggest that furosemide should be used with caution even in non-oliguric critically ill patients until the safety is confirmed in powered study.

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