Clinical characteristics and outcomes of diuretic resistance identified by diuretic effect trajectory: A retrospective cohort study using the MIMIC IV database

To identify diuretic resistance (DR) in patients with congestive heart failure (CHF) during intensive care treatment by analyzing the diuretic effect (DE) and to investigate their clinical characteristics and prognosis. Data of 1,744 patients with CHF in the MIMIC-IV database were analyzed. The trajectory of DE was examined by group-based trajectory modeling and its relationship with the diuretic dose-response then evaluated. The area under the curve (AUC) was used to assess the characteristics of DE at different time points of DR. The association between DE, DR, and clinical outcomes was investigated using logistic and Cox regression with different covariate adjustment strategies. The final model identified four trajectories of DE, among which Class 1 patients were identified as having DR, defined as having a minimal diuretic response of 3.819 mL/mg (95% CI 3.223-4.414, p < 0.001) before peak dosing, and minimal changes in diuretic adjustments. The DE at different time points effectively distinguished DR, with AUC values of 0.966 (95% CI 0.959-0.973) and 0.979 (95% CI 0.973-0.985) and optimal cut-off values of 6.515 and 12.557 at 6 h and 24 h, respectively. The DR group had significantly higher rates of in-hospital mortality (20.08% vs. 8.92%, p < 0.001), all-cause re-admission (23.11% vs. 17.08%, p = 0.012), and one-year mortality (40.45% vs. 26.26%, p < 0.001) compared to those observed in the non-DR group. The method of constructing DE trajectory models offers an effective approach to identify DR and provides novel insights for analyzing its characteristics and prognostic implications.