Association between early decongestion response markers and length of hospital stay in decompensated heart failure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Decompensated heart failure (n=51). Intervention: Higher 48-hour urine output (early decongestion response marker) vs. Lower 48-hour urine output. Primary outcome: Length of hospital stay (LOS) (IRR 1.16, 95% CI 1.03-1.31, p=0.01).

Małgorzata Małek‐Elikowska; Andrzej Szyszka; Julita Fedorowicz; Cyntia J. Szymańska-Łyczkowska; Artur Baszko

doi:10.20452/pamw.17419

October 5, 2026Polskie Archiwum Medycyny WewnętrznejOpen Access

Association between early decongestion response markers and length of hospital stay in decompensated heart failure

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Key result

Higher 48-hour urine output linked to ~16% longer hospital stay in decompensated heart failure.

IRR 1.16
95% CI 1.03-1.31
P=0.01
n=51

Why the study?

Do early decongestion response markers (B-lines, urinary sodium, urine output) predict length of hospital stay in patients with decompensated heart failure?

Key Points

To investigate whether early decongestion markers, including lung ultrasound B-lines, early natriuresis, and urine output, associate with length of hospital stay in acute decompensated heart failure.
Conducted a single-center prospective cohort study of 51 patients (median age 71 years, 55% female) hospitalized for decompensated heart failure between February 2023 and April 2024.
Assessed pulmonary congestion using B-line counts at admission, 24 hours, and 48 hours, alongside 2-hour post-diuretic urinary sodium concentration and cumulative 48-hour urine output.
Higher 48-hour urine output was associated with longer hospital stay (IRR per 1 SD, 1.16; 95% CI, 1.03–1.31; P = 0.01), whereas diuretic efficiency showed no association (IRR per 1 SD, 1.06; 95% CI, 0.94–1.20; P = 0.34).
Prolonged hospital stay was significantly linked to higher baseline NT-proBNP (median 10 167 vs 5591 pg/ml; P = 0.03) and lower eGFR (median 41.5 vs 60.0 ml/min/1.73 m²; P = 0.02).
B-line counts correlated with length of stay at admission (R = 0.29; P = 0.04), 24 hours (R = 0.35; P = 0.01), and 48 hours (R = 0.27; P = 0.05), while 2-hour natriuresis trended inversely (R = –0.25; P = 0.055).

Study Design

Type

Cohort (n=51)

Multicenter

No

Structured PICO

Do early decongestion response markers (B-lines, urinary sodium, urine output) predict length of hospital stay in patients with decompensated heart failure?

P

Population

51 adult patients (median age 71 years, 55% female) hospitalized with decompensated heart failure and treated with intravenous loop diuretics, followed until hospital discharge.

E

Exposure

Assessment of early decongestion response markers (B-line count on lung ultrasound, spot urinary sodium, and urine output) during the first 48 hours of intravenous loop diuretic therapy (furosemide or torsemide).

O

Outcome

Length of hospital stay (LOS), defined as the number of calendar days from hospital admission to discharge or in-hospital death

Main Result

Relative Risk: 1.16 (95% CI 1.03–1.31)

p-value: p=0.01

Limitations

Small sample size (n = 51) limits statistical power and increases the risk of type II error.
Single-center design limits generalizability.
Residual confounding cannot be excluded despite adjustment for key covariates.
Length of stay is influenced by nonclinical factors, such as organizational constraints.
Small number of mortality events precluded meaningful analysis of hard clinical outcomes.
Small sample size (n = 51) limits statistical power and increases the risk of type II error
Single-center design may limit generalizability
Residual confounding cannot be excluded despite adjustment for key covariates
Length of stay is influenced by nonclinical factors such as organizational constraints
Small number of mortality events precluded meaningful analysis of hard clinical outcomes

Implication

In decompensated heart failure, baseline NT-proBNP and eGFR were independent predictors of prolonged hospital stay, whereas early decongestion markers like B-line burden and initial natriuresis were not independently associated with length of stay.

Abstract

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Discussion

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Cite This Study

Małek‐Elikowska et al. (2026) conducted a cohort in Decompensated heart failure (n=51). Higher 48-hour urine output (early decongestion response marker) vs. Lower 48-hour urine output was evaluated on Length of hospital stay (LOS) (IRR 1.16, 95% CI 1.03-1.31, p=0.01). Greater 48-hour urine output was associated with a prolonged length of hospital stay (IRR 1.16 per 1-SD increase) in patients with decompensated heart failure, though this finding was exploratory.

synapsesocial.com/papers/6ac5a0c4164a9ca62de5b33f https://doi.org/10.20452/pamw.17419

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Association between early decongestion response markers and length of hospital stay in decompensated heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between early decongestion response markers and length of hospital stay in decompensated heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Keep reading

More from Polskie Archiwum Medycyny Wewnętrznej