Significance of Diuretic Responsiveness in Intensive Care Unit Patients during the De-Resuscitation Phase: A Retrospective Observational Study

BACKGROUND: Fluid management is a critical aspect of care in critically ill patients. While fluid overload has been linked to adverse outcomes, the balance between achieving a negative fluid balance and preserving kidney function presents a clinical challenge, and the significance of diuretic responsiveness in patients in the de-resuscitation phase remains unclear. OBJECTIVE: This study aimed to evaluate the association between forced diuresis, fluid balance, and clinical outcomes in ICU patients during the de- resuscitation phase. Additionally, we assessed whether changes in kidney function influence prognosis in this patient population. METHODS: A retrospective cohort study was conducted, including 527 critically ill patients treated with furosemide for at least three days during their ICU stay. Fluid balance, kidney function changes (assessed via KDIGO criteria), and clinical outcomes, including ICU mortality and modified SOFA score (excluding renal function), were analyzed. RESULTS: Patients who achieved both a negative fluid balance and improvement in kidney function had the lowest mortality rates and better outcomes. Conversely, those who remained in positive fluid balance despite forced diuresis and exhibited worsening kidney function had the highest mortality and organ dysfunction progression. The presence of vasopressor use and mechanical ventilation was associated with poorer outcomes. CONCLUSION: Among ICU patients undergoing forced diuresis during the de- indicator, non-responsiveness signals a high-risk population. These findings underscore the need for individualized fluid management strategies and highlight the importance of further prospective studies to clarify the role of forced diuresis in critically ill patients.