{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:04:55Z","timestamp":1789736695521,"version":"4.0.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":492,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBZ.A460.23.005"],"award-info":[{"award-number":["SUBZ.A460.23.005"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBZ.A460.24.040"],"award-info":[{"award-number":["SUBZ.A460.24.040"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009687","name":"Uniwersytet Medyczny im. Piast\u00f3w Slaskich we Wroclawiu","doi-asserted-by":"publisher","award":["SUBZ.A460.23.005"],"award-info":[{"award-number":["SUBZ.A460.23.005"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009687","name":"Uniwersytet Medyczny im. Piast\u00f3w Slaskich we Wroclawiu","doi-asserted-by":"publisher","award":["SUBZ.A460.24.040"],"award-info":[{"award-number":["SUBZ.A460.24.040"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aim to identify the most accurate marker for early prediction of poor diuretic response in acute heart failure (AHF) patients with signs of congestion requiring intravenous diuretic treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-centre, prospective observational study, AHF patients with signs of congestion received a standardized intravenous furosemide dose (1 mg\/kg of body weight; 40 mg in bolus and remaining dose in 2 h continuous infusion). Subsequently, we assessed spot urine composition at 2 h post-administration, comparing it with total urine output at 6 h. Various potential urine markers were analysed for predicting urine output using receiver operating characteristic (ROC) curves and logistic regression models. We investigated guideline-recommended markers, including spot urine sodium (UNa+) and its cut-off, and introduced the UNa+\/UCr (urine creatinine concentration) ratio adjusting UNa+ for urine dilution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 111 patients (85% males, 66.4 \u00b1 13.9 years old, NTproBNP 7290 [4493\u201314 582] pg\/ml), there were 18 (16%) with a poor diuretic response (cumulative urine output &amp;lt;600 ml during the first 6 h). The mean 6 h cumulative diuresis in patients with poor and good diuretic response was 406 \u00b1 142 and 2114 \u00b1 1164 ml, respectively, P &amp;lt; 0.005. After an initial evaluation of several potential biomarkers, only UNa+, UCr and UNa+\/UCr were selected as candidates with the highest predictive value. The cut-off for UNa+ adjusted for urine dilution: UNa+\/UCr ratio &amp;lt;0.167 mmol\/mg \u00d7 10\u22121 was determined by ROC analysis with the highest area under the curve (95% confidence interval): 0.956 (0.915\u20130.997), P &amp;lt; 0.001. When compared with the guideline-recommended cut-off (UNa+ &amp;lt;50 mmol\/L as a reference, specificity\u20140.97; sensitivity\u20140.83), the odds ratio (OR) for UNa+\/UCreat to identify a poor diuretic response was 2.5 times greater, regardless of kidney function (OR for estimated glomerular filtration rate in the logistic regression model was 0.978 [0.945\u20131.013, P = 0.222]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The UNa+\/UCr ratio in a spot urine sample 2 h after intravenous diuretic administration is a simple, highly predictive marker for the identification of AHF patients with poor diuretic response, surpassing guidelines-recommended markers like UNa+.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14883","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T05:19:27Z","timestamp":1717996767000},"page":"3438-3442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Spot Urine Sodium-to-Creatinine Ratio Surpasses Sodium in Identifying Poor Diuretic Response in Acute Heart Failure"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-9963","authenticated-orcid":false,"given":"Gracjan","family":"Iwanek","sequence":"first","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Guzik","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw 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