Skip to main content
Journal cover image

A combined clinical and biomarker approach to predict diuretic response in acute heart failure.

Publication ,  Journal Article
ter Maaten, JM; Valente, MAE; Metra, M; Bruno, N; O'Connor, CM; Ponikowski, P; Teerlink, JR; Cotter, G; Davison, B; Cleland, JG; Givertz, MM ...
Published in: Clin Res Cardiol
February 2016

BACKGROUND: Poor diuretic response in acute heart failure is related to poor clinical outcome. The underlying mechanisms and pathophysiology behind diuretic resistance are incompletely understood. We evaluated a combined approach using clinical characteristics and biomarkers to predict diuretic response in acute heart failure (AHF). METHODS AND RESULTS: We investigated explanatory and predictive models for diuretic response--weight loss at day 4 per 40 mg of furosemide--in 974 patients with AHF included in the PROTECT trial. Biomarkers, addressing multiple pathophysiological pathways, were determined at baseline and after 24 h. An explanatory baseline biomarker model of a poor diuretic response included low potassium, chloride, hemoglobin, myeloperoxidase, and high blood urea nitrogen, albumin, triglycerides, ST2 and neutrophil gelatinase-associated lipocalin (r(2) = 0.086). Diuretic response after 24 h (early diuretic response) was a strong predictor of diuretic response (β = 0.467, P < 0.001; r(2) = 0.523). Addition of diuretic response after 24 h to biomarkers and clinical characteristics significantly improved the predictive model (r(2) = 0.586, P < 0.001). CONCLUSIONS: Biomarkers indicate that diuretic unresponsiveness is associated with an atherosclerotic profile with abnormal renal function and electrolytes. However, predicting diuretic response is difficult and biomarkers have limited additive value. Patients at risk of poor diuretic response can be identified by measuring early diuretic response after 24 h.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin Res Cardiol

DOI

EISSN

1861-0692

Publication Date

February 2016

Volume

105

Issue

2

Start / End Page

145 / 153

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Kidney Diseases
  • Humans
  • Heart Failure
  • Furosemide
  • Electrolytes
  • Diuretics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
ter Maaten, J. M., Valente, M. A. E., Metra, M., Bruno, N., O’Connor, C. M., Ponikowski, P., … Voors, A. A. (2016). A combined clinical and biomarker approach to predict diuretic response in acute heart failure. Clin Res Cardiol, 105(2), 145–153. https://doi.org/10.1007/s00392-015-0896-2
Maaten, Jozine M. ter, Mattia A. E. Valente, Marco Metra, Noemi Bruno, Christopher M. O’Connor, Piotr Ponikowski, John R. Teerlink, et al. “A combined clinical and biomarker approach to predict diuretic response in acute heart failure.Clin Res Cardiol 105, no. 2 (February 2016): 145–53. https://doi.org/10.1007/s00392-015-0896-2.
ter Maaten JM, Valente MAE, Metra M, Bruno N, O’Connor CM, Ponikowski P, et al. A combined clinical and biomarker approach to predict diuretic response in acute heart failure. Clin Res Cardiol. 2016 Feb;105(2):145–53.
ter Maaten, Jozine M., et al. “A combined clinical and biomarker approach to predict diuretic response in acute heart failure.Clin Res Cardiol, vol. 105, no. 2, Feb. 2016, pp. 145–53. Pubmed, doi:10.1007/s00392-015-0896-2.
ter Maaten JM, Valente MAE, Metra M, Bruno N, O’Connor CM, Ponikowski P, Teerlink JR, Cotter G, Davison B, Cleland JG, Givertz MM, Bloomfield DM, Dittrich HC, van Veldhuisen DJ, Hillege HL, Damman K, Voors AA. A combined clinical and biomarker approach to predict diuretic response in acute heart failure. Clin Res Cardiol. 2016 Feb;105(2):145–153.
Journal cover image

Published In

Clin Res Cardiol

DOI

EISSN

1861-0692

Publication Date

February 2016

Volume

105

Issue

2

Start / End Page

145 / 153

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Kidney Diseases
  • Humans
  • Heart Failure
  • Furosemide
  • Electrolytes
  • Diuretics