Evidence map›Paper›PMID 30295437›Full record

Observational studyESC heart failure2019

Early urine electrolyte patterns in patients with acute heart failure.

Sean P Collins, Cathy A Jenkins, Adrienne Baughman, Karen F Miller, Alan B Storrow, Jin H Han, Nancy J Brown, Dandan Liu, James M Luther, Candace D McNaughton and 4 more

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in ESC heart failure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 3 pooled it
2.4field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. The value of urinary sodium assessment in acute heart failure.European heart journal. Acute cardiovascular care · 2021
    Pooled it
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  19. Usefulness of natriuresis to predict in-hospital diuretic resistance.American journal of cardiovascular disease · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 2 institutions in 1 country.

Sean P CollinsDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Cathy A JenkinsDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Adrienne BaughmanDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Karen F MillerDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Alan B StorrowDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Jin H HanDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Nancy J BrownDepartment of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Dandan LiuDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
James M LutherDepartment of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
Candace D McNaughtonDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Wesley H SelfDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Dungeng PengDepartment of Internal Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
Jeffrey M TestaniDepartment of Internal Medicine, Division of Cardiology, Yale University, New Haven, CT, USA.
JoAnn LindenfeldDepartment of Internal Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt University Medical Center · USYale University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
6 · The paper itself

Abstract

aimsWe conducted a prospective study of emergency department (ED) patients with acute heart failure (AHF) to determine if worsening HF (WHF) could be predicted based on urinary electrolytes during the first 1-2 h of ED care. Loop diuretics are standard therapy for AHF patients. A subset of patients hospitalized for AHF will develop a blunted natriuretic response to loop diuretics, termed diuretic resistance, which often leads to WHF. Early detection of diuretic resistance could facilitate escalation of therapy and prevention of WHF. METHODS AND

resultsPatients were eligible if they had an ED AHF diagnosis, had not yet received intravenous diuretics, had a systolic blood pressure > 90 mmHg, and were not on dialysis. Urine electrolytes and urine output were collected at 1, 2, 4, and 6 h after diuretic administration. Worsening HF was defined as clinically persistent or WHF requiring escalation of diuretics or administration of intravenous vasoactives after the ED stay. Of the 61 patients who qualified in this pilot study, there were 10 (16.3%) patients who fulfilled our definition of WHF. At 1 h after diuretic administration, patients who developed WHF were more likely to have low urinary sodium (9.5 vs. 43.0 mmol; P < 0.001) and decreased urine sodium concentration (48 vs. 80 mmol/L; P = 0.004) than patients without WHF. All patients with WHF had a total urine sodium of <35.4 mmol at 1 h (100% sensitivity and 60% specificity).

conclusionsOne hour after diuretic administration, a urine sodium excretion of <35.4 mmol was highly suggestive of the development of WHF. These relationships require further testing to determine if early intervention with alternative agents can prevent WHF.

Indexed as

Acute DiseaseAgedBiomarkersDisease ProgressionDiureticsFemaleFollow-Up StudiesHeart FailureHumansMaleMiddle AgedPilot ProjectsPrognosisProspective StudiesSodiumStroke VolumeBiomarkersDiureticsSodiumAcute heart failureDiuretic resistanceEmergency departmentUrine electrolytesWorsening heart failure

Identifiers

PMID30295437
PMCPMC6351901
OpenAlexW2897223717

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.