The effect of adequate urinary output to the first diuretic dose on length of stay in patients hospitalized for acute decompensated heart failure.

BACKGROUND

Intravenous (IV) diuretic use is one of the mainstays of therapy for patients admitted with acute decompensated heart failure (ADHF). While current guidelines recommend administration of at least 2.5 times the daily home diuretic dose for IV diuresis, there is no literature evaluating outcomes for patients reaching their diuretic threshold on their first dose.

OBJECTIVE

This study aimed to evaluate adequate urinary output (UOP) to first IV diuretic dose and length of stay (LOS).

METHODS

This single center retrospective study included patients admitted to the University of Michigan for ADHF (05/2023-11/2024). Patients received diuretics within their first day of hospitalization and their UOP was tracked at 3-, 6-, 12-, and 24-hours post administration. Adequate UOP was defined as an average of >150 mL/hr 3-hours post diuretic administration. The primary outcome studied was LOS. Secondary endpoints included urinary output volume at 6-, 12-, and 24-hours and 30-day readmission.

RESULTS

A total of 988 patients were included. There were 547 patients with adequate UOP and 441 patients with inadequate UOP. Patients with adequate UOP had a median LOS of 5.20 (3.26-8.51) days while patients with inadequate UOP had a median LOS of 5.93 (3.73-9.72) days (p = 0.007). The adequate UOP cohort had higher volumes of UOP at the interval 6-, 12-, and 24-hour marks. There were no observed differences in 30-day readmissions between the adequate and inadequate UOP cohorts (17.0 % vs 17.6 %, p = 0.445).

CONCLUSION

Patients admitted for ADHF who had an adequate UOP had a significantly shorter LOS.