Effect of high-dose furosemide on the prognosis of critically ill patients

Abstract

Purpose: Diuretics are used frequently in critically ill patients. We investigated the effects of furosemide on the prognosis.

Materials and methods: Following a retrospective review of patients admitted to the medical intensive care unit (ICU), we analyzed risk factors with variables including initial furosemide dose for ICU mortality.

Results: A total of 448 patients were included. Total furosemide dose during the first three days of the ICU stay (odds ratio (OR) 2.35, 95% confidence interval (CI) 1.01-5.02) and fluid balance during the same period (OR 3.04, 95% CI 1.46-6.31) were associated with ICU mortality, as were malignancy, chronic furosemide use, and APACHE II score. However, in oliguric patients, positive fluid balance was associated with ICU mortality (OR 22.33, 95% CI 1.82-273.72) but the high-dose furosemide was not. In contrast, in non-oliguric patients, high-dose furosemide was associated with ICU mortality (OR 2.47, 95% CI 1.01-5.68); however, the positive fluid balance showed only a trend for high ICU mortality.

Conclusion: Early high-dose furosemide use is associated with ICU mortality, particularly in non-oliguric patients. We suggest that furosemide should be used with caution even in non-oliguric critically ill patients until the safety is confirmed in powered study.

Keywords: Furosemide; Intensive care units; Mortality; Positive fluid balance.