Akut Kalp Yetmezliğinde Sağkalım Değerlendirmek için Yeni Bir Skor: Diüretik Etkinlik Skoru

Year 2024, , 135 - 143, 30.08.2024

İrem Müge Akbulut , Volkan Kozluca , Türkan Seda Tan Kürklü , Ramtin Ali , Bilge Nazar Ateş , Mehmet Emre Özerdem , Seyhmus Atan , Yakup Yunus Yamantürk , Kerim Esenboğa , Tamer Sayın

https://doi.org/10.29058/mjwbs.1360387

Abstract

Amaç: Akut kalp yetmezliği (AKY) 65 yaş üstü yetişkinlerde hastaneye yatışların en sık nedenidir. Kıvrım diüretikleri, AKY'de konjesyon tedavisinin temel unsurudur. Kıvrım diüretiklerine olan yanıt morbidite ve mortalite ile yakından ilişkilidir. Bu çalışmada; (1) üç ayrı gösterge kullanarak diüretik etkinliğinin (DE) klinik belirleyicilerini ve (2) akut dekompanse kalp yetmezliği hastalarında diüretik etkinliğinin prognostik etkisini araştırmayı amaçladık. Gereç ve Yöntem: Akut dekompanse kalp yetersizliği nedeniyle hastaneye yatırılan 42 hasta çalışmaya dahil edildi. Kıvrım diüretik etkinliğini belirlemek için erken diüretik yanıtı, spot idrar sodyum atılımı (UNa) ve hemokonsantrasyon parametreleri ayrı ayrı değerlendirildi. Bulgular: İyi erken diüretik yanıtı (EDY), başvuru sırasındaki yüksek diyastolik kan basıncı ve eGFR, atriyal fibrilasyon ve intravenöz furosemidin bolus doz şeklind verilmesi ile ilişkili olarak tespit edildi. Hipertansiyon ve başvuru sırasındaki düşük sistolik kan basıncı hemokonsantrasyon ile ters ilişkili olarak bulundu. Sonuç: Diüretik etkinliği kalp ritmi, böbrek fonksiyonu, kan basıncı, hipertansiyon varlığı ve furosemid uygulama şeklinden güçlü bir şekilde etkilenmektedir. Mevcut çalışmada, AKY hastalarında mortaliteyi öngördürmede kullanılabilecek ve DES (diüretik etkinlik skoru) adı verilen yeni, 3 değişkenli bir indeks geliştirildi.

Keywords

diüretik, kalp yetmezliği, sağkalım

A Novel Index for Survival in Acute Heart Failure: Diuretic Efficiency Score

Abstract

Aims: Acute heart failure (AHF) is the leading cause of hospital admissions among adults ≥65. Loop diuretics are the mainstay of treatment of congestion in AHF. Response to loop diuretics is closely related to morbidity and mortality. In this study, we aimed to investigate (1) the clinical determinants of diuretic efficiency (DE) by using three separate indicators for assessing DE and (2) the prognostic effect of diuretic efficiency in acutely decompensated heart failure patients. Methods: 42 consecutive patients admitted to the hospital for acutely decompensated heart failure were included. Early diuretic response, spot urine sodium excretion (UNa), and hemoconcentration were evaluated individually to predict loop diuretic efficiency. Results: Good early diuretic response (EDR) was associated with higher diastolic blood pressure on admission and eGFR, atrial fibrillation, and bolus dosing of intravenous furosemide. Hypertension and low systolic blood pressure on admission were inversely related to hemoconcentration. Conclusion: Diuretic efficiency is strongly influenced by the heart rhythm, renal function, blood pressure, prevalence of hypertension, and schedule of furosemide administration. We developed a novel, 3-variable index called DES (diuretic efficiency score) that predicts mortality in AHF patients. Future research in larger cohorts is needed to validate DES as a predictor of mortality in heart failure.

Keywords

diuretics, heart failure, survival

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