Effects of Nesiritide and Predictors of Urine Output in Acute Decompensated Heart Failure Results From ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure)
Effects of Nesiritide and Predictors of Urine Output in Acute Decompensated Heart Failure Results From ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure)
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DOI：
10.1016/j.jacc.2013.04.073
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发表时间：
2013-09-24
影响因子：
24
通讯作者：
Hernandez, Adrian F.
中科院分区：
文献类型：
--
作者：
Gottlieb, Stephen S.;Stebbins, Amanda;Hernandez, Adrian F.
目的探讨奈西立肽是否能增加充血性心力衰竭患者的利尿作用。在7141例急性失代偿性心力衰竭(ADHF)患者的临床疗效急性研究(ASCEND-HF)中，在标准护理的基础上，随机选择奈西立肽或安慰剂治疗24~168h。奈西立肽对存活率、未来住院时间和症状的影响很小。然而，奈西立肽是否会增加ADHF患者的利尿作用尚不清楚。方法测量5864名受试者的尿量，其中5320人接受环状利尿剂治疗，并记录剂量数据。将非速尿的环状利尿剂转换为等剂量的速尿。共有4881名患者拥有完整的数据。结果奈西立肽组24 h尿量中位数为2,280(1,550，3,280)m l，安慰剂组为2,200(1,550，3,200)m l(p=NS)。环状利尿剂剂量(相当于速尿)为80(40,140)mg，同时使用奈西立肽和安慰剂。利尿剂剂量是尿量的有力预测因素。其他独立预测因素包括：男性、较大的体重指数、较高的舒张压、较高的颈静脉压、近期体重增加和较低的血尿素氮。奈西立肽的加入并没有改变尿量。结论奈西立肽不会增加ADHF患者的尿量。更高的利尿剂剂量是尿量增加的强烈预测因素，但神经激素激活(如血尿素氮浓度)和较低的血压限制了利尿。(C)2013年，由美国心脏病学院基金会
Objectives This study sought to determine if nesiritide increases diuresis in congestive heart failure patients.Background In the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure), 7,141 patients hospitalized with acute decompensated heart failure (ADHF) were randomized to receive nesiritide or placebo for 24 to 168 h, in addition to standard care. There were minimal effects of nesiritide on survival, future hospitalizations, and symptoms. However, whether or not nesiritide increases diuresis in ADHF patients is unknown.Methods Urine output was measured in 5,864 subjects; of these, 5,320 received loop diuretics and had dose data recorded. Loop diuretics other than furosemide were converted to furosemide equivalent doses. A total of 4,881 patients had complete data. We used logistic regression models to identify the impact of nesiritide on urine output and the factors associated with high urine output.Results Median (25th, 75th percentiles) 24-h urine output was 2,280 (1,550, 3,280) ml with nesiritide and 2,200 (1,550, 3,200) ml with placebo (p = NS). Loop diuretic dose (furosemide equivalent) was 80 (40, 140) mg with both nesiritide and placebo. Diuretic dose was a strong predictor of urine output. Other independent predictors included: male sex, greater body mass index, higher diastolic blood pressure, elevated jugular venous pressure, recent weight gain, and lower blood urea nitrogen. The addition of nesiritide did not change urine output. None of the interaction terms between nesiritide and predictors affected the urine output prediction.Conclusions Nesiritide did not increase urine output in patients with ADHF. Higher diuretic dose was a strong predictor of higher urine output, but neurohormonal activation (as evidenced by blood urea nitrogen concentration) and lower blood pressure limited diuresis. (c) 2013 by the American College of Cardiology Foundation