Key result
Furosemide ≥20 mg/day is linked to ~110% higher in-hospital mortality versus lower doses post-cardiac surgery.
Why the study?
Furosemide is widely used perioperatively in cardiac surgery, but its influence on clinical outcomes remains uncertain.
Does high-dose furosemide administration increase mortality and adverse outcomes in patients undergoing cardiac surgery?
Observational (n=6,752)
No
Does high-dose furosemide administration increase mortality and adverse outcomes in patients undergoing cardiac surgery?
Hazard Ratio: 2.099 (95% CI 1.221–3.606)
Absolute Event Rate: 6.7% vs 1.2%
p-value: p=0.007
High-dose furosemide administration after cardiac surgery is associated with increased in-hospital and one-year mortality, as well as prolonged ICU and hospital stays.
May warrant caution with furosemide ≥20 mg/day after cardiac surgery; hypothesis-generating and requires prospective confirmation.
Background: Furosemide is widely used during the perioperative period of cardiac surgery. But the influence of furosemide on outcomes after cardiac surgery remains uncertain. We aim to investigate the relationship between furosemide usage and clinical outcomes among cardiac surgery patients.Methods: Patients who underwent cardiac surgery were identified from MIMIC‑III database. In order to fully and comprehensively assess the influence of furosemide, we transform the total dosage of furosemide into four new variables (total dose of furosemide≥200mg, total dose of furosemide/weight, average daily dose of furosemide, and average daily dose of furosemide≥20mg/d) for further analysis. Cox and logistic regression analysis were used to evaluate the associations between five furosemide related variables and clinical outcomes of cardiac surgery accordingly. Results: A total of 6,752 cardiac surgery patients were included in this analysis. 84.0% patients have used furosemide after cardiac surgery. In the cox regression after adjusted all confounding factors, average daily dose of furosemide (HR 1.07; 95% CI 1.003-1.011; P=0.001), average daily dose of furosemide≥20mg/d (HR 2.099; 95% CI 1.221-3.606; P=0.007) and total dose of furosemide≥200mg (HR1.975; 95% CI 1.095-3.562; P=0.024) were associated with increased risk of in-hospital mortality. Total dose of furosemide (HR 1.00; 95% CI 1.000-1.001; P=0.023) and average daily dose of furosemide (HR 1.003; 95% CI 1.001-1.006; P=0.016) were associated with increased risk of one-year mortality. In the logistic regression after adjusted all confounding factors, all five variables of furosemide usage were significantly increased the risk of length of ICU stay≥3d and mechanical ventilation≥48h; total dosage of furosemide, total dose of furosemide ≥200mg, total dose of furosemide/weight were associated with a higher risk of length of hospital stay≥14d.Conclusions: We demonstrated that high dose of furosemide was associated with increased mortality and adverse outcomes among cardiac surgery patients. It suggests that high-dose furosemide should be cautiously used in cardiac surgery patients.
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Li et al. (2022) conducted an observational in Patients undergoing cardiac surgery (valvular surgery or coronary artery bypass grafting) (n=6,752). High-dose furosemide administration vs. < 20 mg/day average daily dose was evaluated on In-hospital mortality (HR 2.099, 95% CI 1.221-3.606, p=0.007). An average daily dose of furosemide ≥ 20mg was associated with a significantly increased risk of in-hospital mortality (HR 2.099) compared to lower doses in patients undergoing cardiac surgery.
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