{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:15:14Z","timestamp":1792016114831,"version":"4.4.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBZ.A460.25.57"],"award-info":[{"award-number":["SUBZ.A460.25.57"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["IDUB.A46B.24.002"],"award-info":[{"award-number":["IDUB.A46B.24.002"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Identification of poor diuretic response is central in acute heart failure (AHF), yet the recommended post-diuretic urine sodium (uNa+) thresholds have neither been prospectively derived nor validated. We aimed to derive and validate clinically actionable urinary biomarker thresholds to identify inadequate diuretic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is prospective derivation-validation study. Optimal thresholds were determined based on spot urinary biomarkers measured 2\u2005h after loop diuretic administration and 6\u2005h diuresis. Diuretic resistance was defined as urine output &amp;lt; 500\u2005mL\/6\u2005h, and insufficient diuretic response as &amp;lt;1000\u2005mL\/6h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the derivation cohort (n = 336), optimal uNa thresholds were &amp;lt;60 and &amp;lt;90\u2005mmol\/L. For diuretic resistance, uNa+ &amp;lt; 60\u2005mmol\/L showed .80 [95% confidence interval (CI): .65-.90] sensitivity, .94 (95% CI: .90-.96) specificity, and an area under the curve of .93 (95% CI: .90-.97). For insufficient diuretic response, uNa+ &amp;lt; 90\u2005mmol\/L showed .80 (95% CI: .69-.86) sensitivity, .84 (95% CI: .787-.878) specificity, and an area under the curve of .86 (95% CI: .83-.93). In the validation cohort (n = 141), uNa+ &amp;lt; 60\u2005mmol\/L had numerically higher sensitivity than uNa+ &amp;lt; 50\u2005mmol\/L [.87 (95% CI: .62-.98) vs. .73 (95% CI: .48-.89)], with similar specificity [.94 (95% CI: .89-.97) vs. .97 (95% CI: .92-.99)] for diuretic resistance. For insufficient diuretic response, uNa+ &amp;lt; 90\u2005mmol\/L had higher sensitivity (.86, 95% CI: .71-.94) than lower thresholds, with a specificity of .83 (95% CI: .75\u2212.89).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Data-derived post-diuretic uNa+ thresholds of &amp;lt;60 and &amp;lt;90\u2005mmol\/L identify diuretic resistance and insufficient diuretic response, respectively. Further research and external validation are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag216","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:53:04Z","timestamp":1783597984000},"source":"Crossref","is-referenced-by-count":3,"title":["Urinary biomarker thresholds to detect diuretic resistance and insufficient diuretic response in acute heart failure"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-7722","authenticated-orcid":false,"given":"Jan","family":"Biegus","sequence":"first","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-9963","authenticated-orcid":false,"given":"Gracjan","family":"Iwanek","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Testani","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zymli\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Nuniez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Clinico Universitario, Instituto de Investigacion Sanitaria del Hospital Clinico de Valencia (INCLIVA) , Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-7871","authenticated-orcid":false,"given":"Matteo","family":"Pagnesi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenika","family":"Jankowiak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9711-6568","authenticated-orcid":false,"given":"Mateusz","family":"Guzik","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Tymk\u00f3w","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amadeusz","family":"Oleszczak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Deus Corp , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Gajewski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 ,","place":["Poland"]},{"name":"Department of Cardiology, Jan Mikulicz Radecki University Hospital in Wroc\u0142aw , Borowska 213, Wroclaw 50-556 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