Prognostic Value of Fractional Excretion of Urea Nitrogen at Discharge in Acute Decompensated Heart Failure.

• Material Type: 博士論文
• Title: Prognostic Value of Fractional Excretion of Urea Nitrogen at Discharge in Acute Decompensated Heart Failure.
• Author/Editor: Nogi, Kazutaka; Kawakami, Rika; Ueda, Tomoya; Nogi, Maki; Ishihara, Satomi; Nakada, Yasuki; Hashimoto, Yukihiro; Nakagawa, Hitoshi; Nishida, Taku; Seno, Ayako; Onoue, Kenji; Soeda, Tsunenari; Watanabe, Makoto; Saito, Yoshihiko
• Author Heading: Nogi, Kazutaka; Kawakami, Rika; Ueda, Tomoya; Nogi, Maki; Ishihara, Satomi; Nakada, Yasuki; Hashimoto, Yukihiro; Nakagawa, Hitoshi; Nishida, Taku; Seno, Ayako; Onoue, Kenji; Soeda, Tsunenari; Watanabe, Makoto; Saito, Yoshihiko
• Publication, Distribution, etc.: American Heart Association
• Publication Date: 2021-08-17
• Publication Date (W3CDTF): 2021-08-17
• Alternative Title: 急性心不全における退院時の尿素窒素分画排泄率の予後判定への有用性
• Periodical title: Journal of the American Heart Association
• No. or year of volume/issue: 10 16
• Volume: 10
• Issue: 16
• Pages: Article No.e020480-
• ISSN (Periodical Title): ISSN : 2047-9980
• Degree grantor/type: 奈良県立医科大学
• Date Granted: 2022-03-15
• Dissertation Number: 甲第814号
• Degree Type: 博士（医学）
• Text Language Code: eng
• Subject Heading: prognosis; fractional excretion of urea nitrogen; diuretic; heart failure
• Target Audience: 一般
• Note (General): type:Thesis; Background Maintaining euvolemia is crucial for improving prognosis in acute decompensated heart failure (ADHF). Although fractional excretion of urea nitrogen (FEUN) is used as a body fluid volume index in patients with acute kidney injury, the clinical impact of FEUN in patients with ADHF remains unclear. This study aimed to investigate whether FEUN can determine the long-term prognosis in patients with ADHF. Methods and Results We retrospectively identified 466 patients with ADHF who had FEUN measured at discharge between April 2011 and December 2018. The primary endpoint was post-discharge all-cause death. Patients were divided into two groups according to a FEUN cut-off value of 35%, commonly used in pre-renal failure. The FEUN <35% (low-FEUN) group included 224 patients (48.1%), and the all-cause mortality rate for the total cohort was 37.1%. The log-rank test revealed that the low-FEUN group had a significantly higher rate of all-cause death compared to the FEUN equal to or greater than 35% (high-FEUN) group (P<0.001). Multivariate Cox proportional hazards model analysis revealed that low-FEUN was associated with post-discharge all-cause death, independently of other heart failure risk factors (hazard ratio, 1.467; 95% CI, 1.030-2.088, P=0.033). The risk of low-FEUN compared to high-FEUN in post-discharge all-cause death was consistent across all subgroups; however, the effects tended to be modified by renal function (threshold: 60 mL/min/1.73 m2, interaction P=0.069). Conclusions Our study suggests that FEUN may be a novel surrogate marker of volume status in patients with ADHF requiring diuretics.; 博士（医学）・甲第814号・令和4年3月15日; Copyright © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License(https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.; identifier:Journal of the American Heart Association Vol.10 No.16 Article No.e020480 (2021 Aug); identifier:20479980; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3997; identifier:Journal of the American Heart Association, 10(16): Article No.e020480
• Source: fulltext; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3997/1/01%e7%94%b2814%e6%9c%ac%e6%96%87%e3%81%ae%e8%a6%81%e6%97%a8.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3997/2/02%e7%94%b2814%e5%af%a9%e6%9f%bb%e8%a6%81%e6%97%a8.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3997/3/03%e7%94%b2814%e6%9c%ac%e6%96%87.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3997/4/04%e7%94%b2814Suppl..pdf
• Access Restrictions: インターネット公開
• Related Material (DOI): 10.1161/JAHA.120.020480
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU