Key result
A fractional excretion of urea nitrogen <35% at discharge was associated with increased post-discharge all-cause death in acute decompensated heart failure (HR 1.467; 95% CI 1.030-2.088; P=0.033).
Why the study?
Maintaining euvolemia is crucial in acute decompensated heart failure, but the clinical impact of fractional excretion of urea nitrogen (FEUN) on long-term prognosis remains unclear.
Does a fractional excretion of urea nitrogen (FEUN) <35% at discharge predict post-discharge all-cause death in patients with acute decompensated heart failure?
Cohort (n=466)
Does a fractional excretion of urea nitrogen (FEUN) <35% at discharge predict post-discharge all-cause death in patients with acute decompensated heart failure?
Hazard Ratio: 1.467 (95% CI 1.03–2.088)
p-value: p=0.033
A fractional excretion of urea nitrogen (FEUN) <35% at discharge is an independent predictor of long-term all-cause mortality in patients with acute decompensated heart failure.
May support FEUN-guided risk stratification at ADHF discharge; leaves open incremental value and need for prospective validation.
Background Maintaining euvolemia is crucial for improving prognosis in acute decompensated heart failure (ADHF). Although fractional excretion of urea nitrogen (FEUN) is used as a body fluid volume index in patients with acute kidney injury, the clinical impact of FEUN in patients with ADHF remains unclear. This study aimed to investigate whether FEUN can determine the long‐term prognosis in patients with ADHF. Methods and Results We retrospectively identified 466 patients with ADHF who had FEUN measured at discharge between April 2011 and December 2018. The primary endpoint was post‐discharge all‐cause death. Patients were divided into two groups according to a FEUN cut‐off value of 35%, commonly used in pre‐renal failure. The FEUN <35% (low‐FEUN) group included 224 patients (48.1%), and the all‐cause mortality rate for the total cohort was 37.1%. The log‐rank test revealed that the low‐FEUN group had a significantly higher rate of all‐cause death compared to the FEUN equal to or greater than 35% (high‐FEUN) group ( P <0.001). Multivariate Cox proportional hazards model analysis revealed that low‐FEUN was associated with post‐discharge all‐cause death, independently of other heart failure risk factors (hazard ratio, 1.467; 95% CI, 1.030–2.088, P =0.033). The risk of low‐FEUN compared to high‐FEUN in post‐discharge all‐cause death was consistent across all subgroups; however, the effects tended to be modified by renal function (threshold: 60 mL/min/1.73 m 2 , interaction P =0.069). Conclusions Our study suggests that FEUN may be a novel surrogate marker of volume status in patients with ADHF requiring diuretics.
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Nogi et al. (2021) conducted a cohort in Acute Decompensated Heart Failure (n=466). Fractional excretion of urea nitrogen <35% vs. Fractional excretion of urea nitrogen ≥35% was evaluated on post-discharge all-cause death (HR 1.467, 95% CI 1.030-2.088, p=0.033). A fractional excretion of urea nitrogen <35% at discharge was associated with increased post-discharge all-cause death in acute decompensated heart failure (HR 1.467; 95% CI 1.030-2.088; P=0.033).
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