Assessment of the impact of furosemide use on outcomes in patients with intra-abdominal hypertension: a retrospective cohort study from the MIMIC-IV database

OBJECTIVE: This study aims to explore the effect of furosemide on the prognosis of patients with intra-abdominal hypertension (IAH). METHODS: A retrospective cohort study was conducted utilizing data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The analysis encompassed adult patients diagnosed with intra-abdominal hypertension. The exposure factor in this study was defined as the administration of furosemide during the intensive care unit (ICU) stay. The primary outcome measured was all-cause mortality at 28 days, while the secondary outcomes included all-cause mortality at 7 days, 90 days, and 180 days. Both propensity score matching (PSM) and COX multivariate regression analysis were employed to adjust for potential confounding variables.​ RESULTS: A total of 859 critically ill patients with IAH were enrolled, with 534 receiving furosemide and 325 not. After PSM, mortality was significantly higher in the non-furosemide group across all time points (7 days: 6.7% vs. 27.3%; 28 days: 25.3% vs. 47.8%; 90 days: 30.0% vs. 50.6%; 180 days: 30.8% vs. 50.6%; all P < 0.001). Multivariate COX regression analysis identified furosemide use as a protective factor for 7-day, 28-day, 90-day, and 180-day all-cause mortality in IAH patients (7-day: HR = 0.19, 95%CI 0.11–0.34, P < 0.001; 28-day: HR = 0.35, 95%CI 0.26–0.48, P < 0.001; 90-day: HR = 0.39, 95%CI 0.29–0.52, P < 0.001; 180-day: HR = 0.40, 95%CI 0.30–0.54, P < 0.001). Subgroup analysis confirmed consistent beneficial effects across different baseline characteristics. CONCLUSION: Furosemide use was associated with reduced all-cause mortality in critically ill patients with IAH. Additional high-caliber prospective investigations are warranted to validate these findings.