Association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury receiving renal replacement therapy: a retrospective observational cohort study based on MIMIC-IV database

Objective To investigate the association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury (SAKI) receiving renal replacement therapy (RRT). Design A retrospective observational cohort study. Setting The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, which contains clinical data from more than 380 000 patients admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center from 2008 to 2019. Participants All adult patients with SAKI receiving RRT were enrolled. Data for each patient within the first 24 hours of ICU admission were extracted from the MIMIC-IV database. Primary and secondary outcome measures The primary outcome was in-hospital mortality, and the secondary outcome was the length of hospital stay, length of ICU stay, RRT-free time and ventilator-free time. Logistic regression was used to investigate the association between furosemide administration and in-hospital mortality. Subgroup analysis was employed to explore the potential sources of heterogeneity. Results A total of 1663 patients with SAKI receiving RRT were enrolled in the study, of whom 991 patients (59.6%) were retrospectively allocated to the Furosemide group and 672 (40.4%) patients to the non-furosemide group. Univariate and multivariate logistic regression showed that furosemide administration was associated with reduced in-hospital mortality, respectively ((OR 0.77; 95% CI 0.63 to 0.93; p=0.008 < 0.05), (OR 0.59; 95% CI 0.46 to 0.75; p<0.001)). The association remained robust to different ways of adjusting for baseline confounding (all p<0.05). Subgroup analysis suggested that AKI-stage may be a source of heterogeneity. Patients in the furosemide group also had longer RRT-free time (p<0.001) and longer ventilator-free time (p<0.001) than those in the non-furosemide group. Conclusions Furosemide is associated with decreased in-hospital mortality, longer RRT-free time and ventilator-free time in patients with SAKI receiving RRT.

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