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O Efeito da Administração Precoce de Solução Salina Hipertônica na Insuficiência Cardíaca Descompensada Aguda
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Abstract Background There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF). Objectives This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes. Methods In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%. Results The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups. Conclusion HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients. (HSS . (ADHF) (LD levels outcomes casecontrol case control 17 93 (9 females78 females 78 females/7 males 1 2022 31 HSSLD WRF. WRF (WRF) allcause all cause followup. followup follow up. up follow-up 5% characteristicsA characteristics A st 3975 (397 30005150 3000 5150 [3000-5150 258 20003250, 20003250 2000 3250 , [2000-3250] p0001 p 0 001 nd 116.00 11600 116 00 (116.0 82.75126.00 827512600 82.75 126.00 82 75 126 [82.75-126.00 6850 68 50 68.5 54.0089.75, 54008975 54.00 89.75 54 89 [54.00-89.75] LDWhen When Na 137.00 13700 137 (137.0 131.75140.00 1317514000 131.75 131 140 [131.75-140.00 14000 140.0 136.00142.25, 1360014225 136.00 142.25 136 142 25 [136.00-142.25] p=0.00 13900 139 139.0 137.00141.00 1370014100 141.00 141 [137.00-141.00 136.00140.00, 1360014000 [136.00-140.00] p0470 0470 p=.047 LD) 99.00 9900 99 (99.0 94.00103.25 940010325 94.00 103.25 94 103 [94.00-103.25 99.0096.00103.00, 9900960010300 96.00 103.00 96 99.00[96.00-103.00] p=0.295, p0295 p=0.295 295 p=0.295) 48.50 4850 48 (48.5 29.7572.50 29757250 29.75 72.50 29 72 [29.75-72.5 5000 50.0 35.5063.50, 35506350 35.50 63.50, 35 63 [35.50-63.50 p=0.616, p0616 p=0.616 616 p=0.616) 120 20 (1.2 0.901.70 090170 0.90 1.70 90 70 [0.90-1.70 1.2 1.001.50, 100150 1.00 1.50 [1.00-1.50] p=0.218 p0218 218 Cl (Cl- 10200 102 102.0 99.00106.00 990010600 106.00 106 [99.00-106.00 9800 98 98.0 95.00103.00, 950010300 95.00 95 [95.00-103.00] eGFR 5600 56 56.0 41.0071.00 41007100 41.00 71.00 41 71 [41.00-71.00 5500 55 55.0 35.0071.00, 35007100 35.00 [35.00-71.00] p0050 050 p=0.050 creatinine1.10 creatinine110 1.10 10 creatinine:1.1 0.901.40 090140 1.40 40 [0.90-1.40 0.901.70, p=0.009. p0009 p=0.009 009 p=0.009) 16.1% 161 16 (16.1 355 35.5% p=0.007, p0007 p=0.007 007 p=0.007) 4 ( 37 3 7 [3-7 47, 47 [4-7] p=0.004 p0004 004 Inhospital therapy Therefore (ADHF 9 females7 females/ 202 (WRF 397 (39 3000515 300 515 [3000-515 2000325 200 325 [2000-3250 p000 116.0 1160 11 (116. 75126 82.75126.0 82751260 8275 82.7 12600 126.0 8 12 [82.75-126.0 685 68. 0089 54.0089.75 5400897 5400 54.0 8975 89.7 [54.00-89.75 137.0 1370 13 (137. 75140 131.75140.0 131751400 13175 131.7 14 [131.75-140.0 1400 140. 00142 136.00142.25 136001422 13600 136.0 14225 142.2 2 [136.00-142.25 p=0.0 1390 139. 00141 137.00141.0 137001410 14100 141.0 [137.00-141.0 00140 136.00140.00 136001400 [136.00-140.00 p047 047 p=.04 99.0 990 (99. 00103 94.00103.2 94001032 9400 94.0 10325 103.2 [94.00-103.2 0096 99.0096.00103.00 990096001030 9600 96.0 10300 103.0 99.00[96.00-103.00 p029 p=0.29 48.5 485 (48. 7572 29.7572.5 2975725 2975 29.7 7250 72.5 [29.75-72. 500 50. 5063 35.5063.50 3550635 3550 35.5 6350 63.50 [35.50-63.5 p061 p=0.61 61 (1. 901 0.901.7 09017 090 0.9 170 1.7 [0.90-1.7 1. 1.001.50 10015 100 1.0 150 1.5 [1.00-1.50 p=0.21 p021 21 (Cl 1020 102. 00106 99.00106.0 99001060 10600 106.0 [99.00-106.0 980 98. 95.00103.00 95001030 9500 95.0 [95.00-103.00 560 56. 0071 41.0071.0 4100710 4100 41.0 7100 71.0 [41.00-71.0 550 55. 35.0071.00 3500710 3500 35.0 [35.00-71.00 p005 05 p=0.05 creatinine1 creatinine1.1 creatinine11 110 1.1 creatinine:1. 0.901.4 09014 1.4 [0.90-1.4 16.1 (16. [3- [4-7 39 (3 300051 30 51 [3000-51 200032 32 [2000-325 p00 116. (116 7512 82.75126. 8275126 827 82. 1260 126. [82.75-126. 008 54.0089.7 540089 540 54. 897 89. [54.00-89.7 137. (137 7514 131.75140. 13175140 1317 131. [131.75-140. 0014 136.00142.2 13600142 1360 136. 1422 142. [136.00-142.2 p=0. 137.00141. 13700141 1410 141. [137.00-141. 136.00140.0 13600140 [136.00-140.0 p04 04 p=.0 99. (99 0010 94.00103. 9400103 940 94. 1032 103. [94.00-103. 99.0096.00103.0 99009600103 960 96. 1030 99.00[96.00-103.0 p02 p=0.2 48. (48 757 29.7572. 297572 297 29. 725 72. [29.75-72 506 35.5063.5 355063 35. 635 63.5 [35.50-63. p06 p=0.6 (1 0.901. 0901 09 0. [0.90-1. 1.001.5 1001 15 [1.00-1.5 99.00106. 9900106 1060 106. [99.00-106. 95.00103.0 9500103 950 95. [95.00-103.0 41.0071. 410071 410 41. 710 71. [41.00-71. 35.0071.0 350071 350 [35.00-71.0 creatinine1. creatinine:1 16. (16 [3 [4- 30005 [3000-5 20003 [2000-32 p0 (11 751 82.75126 827512 [82.75-126 54.0089. 54008 [54.00-89. (13 131.75140 1317514 [131.75-140 136.00142. 1360014 [136.00-142. p=0 137.00141 1370014 [137.00-141 136.00140. [136.00-140. p=. 94.00103 940010 [94.00-103 99.0096.00103. 9900960010 99.00[96.00-103. 29.7572 29757 [29.75-7 35.5063. 35506 63. [35.50-63 0.901 [0.90-1 1.001. [1.00-1. 99.00106 990010 [99.00-106 95.00103. 950010 [95.00-103. 41.0071 41007 [41.00-71 35.0071. 35007 [35.00-71. creatinine: [ [4 [3000- [2000-3 82.7512 82751 [82.75-12 54.0089 [54.00-89 131.7514 131751 [131.75-14 136.00142 136001 [136.00-142 p= 137.0014 137001 [137.00-14 136.00140 [136.00-140 94.0010 94001 [94.00-10 99.0096.00103 990096001 99.00[96.00-103 29.757 [29.75- 35.5063 [35.50-6 [0.90- 1.001 [1.00-1 99.0010 99001 [99.00-10 95.00103 95001 [95.00-103 41.007 [41.00-7 35.0071 [35.00-71 [3000 [2000- 82.751 [82.75-1 54.008 [54.00-8 131.751 [131.75-1 136.0014 [136.00-14 137.001 [137.00-1 94.001 [94.00-1 99.0096.0010 99009600 99.00[96.00-10 [29.75 35.506 [35.50- [0.90 [1.00- 99.001 [99.00-1 95.0010 [95.00-10 [41.00- 35.007 [35.00-7 [300 [2000 [82.75- [54.00- [131.75- 136.001 [136.00-1 [137.00- [94.00- 99.0096.001 9900960 99.00[96.00-1 [29.7 [35.50 [0.9 [1.00 [99.00- 95.001 [95.00-1 [41.00 [35.00- [30 [200 [82.75 [54.00 [131.75 [136.00- [137.00 [94.00 99.0096.00 990096 99.00[96.00- [29. [35.5 [0. [1.0 [99.00 [95.00- [41.0 [35.00 [20 [82.7 [54.0 [131.7 [136.00 [137.0 [94.0 99.0096.0 99009 99.00[96.00 [29 [35. [0 [1. [99.0 [95.00 [41. [35.0 [2 [82. [54. [131. [136.0 [137. [94. 99.0096. 99.00[96.0 [35 [1 [99. [95.0 [41 [82 [54 [131 [136. [137 [94 99.0096 99.00[96. [99 [95. [8 [5 [13 [136 [9 99.009 99.00[96 [95 99.00[9 99.00[
Resumo Fundamento Não houve evidência científica sobre o tratamento inicial com solução salina hipertônica (SSH) na insuficiência cardíaca agudamente descompensada (ICAD). Objetivos Este estudo avaliou o impacto do uso de SSH junto com um diurético de alça (DA) como o primeiro tratamento diurético para ICAD, com foco na função renal, níveis de eletrólitos e resultados clínicos. Métodos Neste estudo retrospectivo de caso-controle, 171 pacientes adultos (93 mulheres/78 homens) com ICAD foram incluídos entre 1º de janeiro de 2022 e 31 de dezembro de 2022. Os pacientes foram alocados em dois grupos: combinação inicial de SSH+DA e DA padronizada. O desfecho primário foi piora da função renal (PFR). A hospitalização por IC e a mortalidade por todas as causas foram avaliadas durante 6 meses de acompanhamento. O nível de significância adotado na análise estatística foi de 5%. Resultados Os grupos exibiram semelhanças nas características basais. Diurese significativamente maior no 1º dia (3975 [3000-5150] vs. 2583 [2000-3250], p=0,001) e natriurese na 2ª hora (116,00 [82,75-126,00] vs. 131,75-140,00] vs. 94,00-103,25] vs. 99,00 [96,00-103,00], p=0,295), TFG (48,50 [29,75-72,50 vs. 50,00[35,50-63,50, p=0,616) e creatinina (1,20 [0,90-1,70] vs. 1,20 [1,00-1,50], p=0,218) permaneceu estável no grupo SSH combinado inicial quando comparado ao grupo DA padronizado (Cl-: 102,00[99,00-106,00] vs. 98,00[95,00-103,00], p=0,001, TFGe: 56,00 [41,00-71,00] vs. 55,00[35,00-71,00], p=0,050, creatinina: 1,10[0,90-1,40] vs. 1,20 [0,90-1,70], p=0,009). A piora da função renal (16,1% vs. 35,5%, p = 0,007) e o tempo de internação hospitalar (4 dias [3-7] vs. 5 dias [4-7], p = 0,004) foram menores na combinação inicial SSH+DA em comparação com o DA padronizado. A mortalidade hospitalar, a hospitalização por IC e a mortalidade por todas as causas foram semelhantes entre os dois grupos. Conclusão SSH como terapia inicial, quando combinada com DA, pode proporcionar uma diurese segura e eficaz sem prejudicar a função renal na ICAD. Portanto, a SSH pode levar a um menor tempo de internação hospitalar para esses pacientes. (SSH . (ICAD) (DA clínicos casocontrole, casocontrole caso controle, controle caso-controle 17 93 (9 mulheres78 mulheres 78 mulheres/7 homens º 202 3 SSHDA padronizada PFR. PFR (PFR) acompanhamento 5% basais 3975 (397 30005150 3000 5150 [3000-5150 vs 258 20003250, 20003250 2000 3250 , [2000-3250] p=0,001 p0001 0 001 ª 116,00 11600 116 00 (116,0 82,75126,00 827512600 82,75 126,00 82 75 126 [82,75-126,00 131,75140,00 1317514000 131,75 140,00 131 140 131,75-140,00 94,00103,25 940010325 94,00 103,25 94 103 25 94,00-103,25 9900 99 99,0 96,00103,00, 960010300 96,00 103,00 96 [96,00-103,00] p=0,295, p0295 p=0,295 295 p=0,295) 48,50 4850 48 50 (48,5 29,7572,50 29757250 29,75 72,50 29 72 [29,75-72,5 50,0035,5063,50, 500035506350 50,00 35,50 63,50, 35 63 50,00[35,50-63,50 p=0,616 p0616 616 120 1 20 (1,2 0,901,70 090170 0,90 1,70 90 70 [0,90-1,70 1,2 1,001,50, 100150 1,00 1,50 [1,00-1,50] p=0,218 p0218 218 Cl (Cl- 102,0099,00106,00 10200990010600 102,00 106,00 102 106 102,00[99,00-106,00 98,0095,00103,00, 9800950010300 98,00 95,00 98 95 98,00[95,00-103,00] TFGe 5600 56 56,0 41,0071,00 41007100 41,00 71,00 41 71 [41,00-71,00 55,0035,0071,00, 550035007100 55,00 35,00 55 55,00[35,00-71,00] p0050 050 p=0,050 1,100,901,40 110090140 1,10 1,40 10 40 1,10[0,90-1,40 0,901,70, p=0,009. p0009 p=0,009 009 p=0,009) 16,1% 161 16 (16,1 355 35,5% 0,007 0007 007 4 ( 37 7 [3-7 47, 47 [4-7] 0,004 0004 004 Portanto (ICAD 9 mulheres7 mulheres/ (PFR 397 (39 3000515 300 515 [3000-515 2000325 200 325 [2000-3250 p=0,00 p000 116,0 1160 11 (116, 75126 82,75126,0 82751260 8275 82,7 12600 126,0 8 12 [82,75-126,0 75140 131,75140,0 131751400 13175 131,7 14000 140,0 13 14 131,75-140,0 00103 94,00103,2 94001032 9400 94,0 10325 103,2 2 94,00-103,2 990 99, 96,00103,00 96001030 9600 96,0 10300 103,0 [96,00-103,00 p029 p=0,29 48,5 485 (48, 7572 29,7572,5 2975725 2975 29,7 7250 72,5 [29,75-72, 0035 5063 50,0035,5063,50 50003550635 5000 50,0 3550 35,5 6350 63,50 50,00[35,50-63,5 p=0,61 p061 61 (1, 901 0,901,7 09017 090 0,9 170 1,7 [0,90-1,7 1, 1,001,50 10015 100 1,0 150 1,5 [1,00-1,50 p=0,21 p021 21 (Cl 0099 00106 102,0099,00106,0 1020099001060 10200 102,0 10600 106,0 102,00[99,00-106,0 0095 98,0095,00103,00 980095001030 9800 98,0 9500 95,0 98,00[95,00-103,00 560 56, 0071 41,0071,0 4100710 4100 41,0 7100 71,0 [41,00-71,0 55,0035,0071,00 55003500710 5500 55,0 3500 35,0 55,00[35,00-71,00 p005 05 p=0,05 1,100,901,4 11009014 110 1,1 1,4 1,10[0,90-1,4 16,1 (16, 0,00 000 [3- [4-7 39 (3 300051 30 51 [3000-51 200032 32 [2000-325 p=0,0 p00 116, (116 7512 82,75126, 8275126 827 82, 1260 126, [82,75-126, 7514 131,75140, 13175140 1317 131, 1400 140, 131,75-140, 0010 94,00103, 9400103 940 94, 1032 103, 94,00-103, 96,00103,0 9600103 960 96, 1030 [96,00-103,0 p02 p=0,2 48, (48 757 29,7572, 297572 297 29, 725 72, [29,75-72 003 506 50,0035,5063,5 5000355063 500 50, 35, 635 63,5 50,00[35,50-63, p=0,6 p06 (1 0,901, 0901 09 0, [0,90-1, 1,001,5 1001 15 [1,00-1,5 102,0099,00106, 102009900106 1020 102, 1060 106, 102,00[99,00-106, 98,0095,00103,0 98009500103 980 98, 950 95, 98,00[95,00-103,0 41,0071, 410071 410 41, 710 71, [41,00-71, 55,0035,0071,0 5500350071 550 55, 350 55,00[35,00-71,0 1,100,901, 1100901 1,10[0,90-1, 16, (16 0,0 [3 [4- 30005 [3000-5 20003 [2000-32 p=0, p0 (11 751 82,75126 827512 [82,75-126 131,75140 1317514 131,75-140 94,00103 940010 94,00-103 96,00103, 960010 [96,00-103, 29,7572 29757 [29,75-7 50,0035,5063, 500035506 63, 50,00[35,50-63 0,901 [0,90-1 1,001, [1,00-1, 102,0099,00106 10200990010 102,00[99,00-106 98,0095,00103, 9800950010 98,00[95,00-103, 41,0071 41007 [41,00-71 55,0035,0071, 550035007 55,00[35,00-71, 1,100,901 110090 1,10[0,90-1 [ [4 [3000- [2000-3 p=0 82,7512 82751 [82,75-12 131,7514 131751 131,75-14 94,0010 94001 94,00-10 96,00103 96001 [96,00-103 29,757 [29,75- 50,0035,5063 50003550 50,00[35,50-6 [0,90- 1,001 [1,00-1 102,0099,0010 1020099001 102,00[99,00-10 98,0095,00103 980095001 98,00[95,00-103 41,007 [41,00-7 55,0035,0071 55003500 55,00[35,00-71 1,100,90 11009 1,10[0,90- [3000 [2000- p= 82,751 [82,75-1 131,751 131,75-1 94,001 94,00-1 96,0010 [96,00-10 [29,75 50,0035,506 5000355 50,00[35,50- [0,90 [1,00- 102,0099,001 102009900 102,00[99,00-1 98,0095,0010 98009500 98,00[95,00-10 [41,00- 55,0035,007 5500350 55,00[35,00-7 1,100,9 1100 1,10[0,90 [300 [2000 [82,75- 131,75- 94,00- 96,001 [96,00-1 [29,7 50,0035,50 500035 50,00[35,50 [0,9 [1,00 102,0099,00 10200990 102,00[99,00- 98,0095,001 9800950 98,00[95,00-1 [41,00 55,0035,00 550035 55,00[35,00- 1,100, 1,10[0,9 [30 [200 [82,75 [96,00- [29, 50,0035,5 50003 50,00[35,5 [0, [1,0 102,0099,0 1020099 102,00[99,00 98,0095,00 980095 98,00[95,00- [41,0 55,0035,0 55003 55,00[35,00 1,100 1,10[0, [20 [82,7 [96,00 [29 50,0035, 50,00[35, [0 [1, 102,0099, 102009 102,00[99,0 98,0095,0 98009 98,00[95,00 [41, 55,0035, 55,00[35,0 1,10[0 [2 [82, [96,0 50,0035 50,00[35 [1 102,0099 102,00[99, 98,0095, 98,00[95,0 [41 55,0035 55,00[35, 1,10[ [82 [96, 50,003 50,00[3 102,009 102,00[99 98,0095 98,00[95, 55,003 55,00[35 [8 [96 50,00[ 102,00[9 98,009 98,00[95 55,00[3 [9 102,00[ 98,00[9 55,00[ 98,00[
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