{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:02:35Z","timestamp":1789696955643,"version":"4.0.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We aimed to develop a machine learning-based tool for accurate quantitative prediction of diuretic response in acute heart failure (AHF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled 296 AHF patients (20% female, mean age 68 \u00b1 13 years, mean estimated glomerular filtration rate (eGFR) 62 \u00b1 30\u2005ml\/min\/1.73m2, median NT-proBNP 7112 [4082\u201314 400] pg\/ml) in a single-centre derivation\/validation study. A random forest regression model was developed using derivation (n = 50) and optimization (n = 246) cohorts and externally validated in an independent cohort (n = 50; mean age 69 \u00b1 14 years, mean eGFR 56 \u00b1 27\u2005ml\/min\/1.73m2). Predictors were eGFR, spot urine sodium (uNa), and urine creatinine (uCr) obtained 2\u2005h after intravenous furosemide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the validation cohort (n = 50), the median observed 6\u2005h urine output was 1220 [950\u20131750] ml vs model-estimated 1446 [957\u20131749] ml (P = .480). Observed and estimated values showed a strong positive correlation (r = 0.90, 95% CI: 0.83\u20130.94, P &amp;lt; .0001), with a mean absolute error of 413\u2005ml and a mean bias of 67 \u00b1 383\u2005ml on the Bland\u2013Altman analysis. The model correctly classified 44\/50 patients (88%) into predefined diuresis categories (\u2264900, 900\u20131800, and \u22651800\u2005ml), compared with 58% for the reference natriuretic response prediction equation. Mean absolute error decreased progressively by approximately 200\u2005ml per 100 additional patients, confirming data-driven performance improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A three-variable machine learning model (eGFR, uNa, and uCr at 2\u2005h post-diuretic) predicted 6\u2005h urine output with high accuracy in AHF and demonstrated adaptive improvement with expanding training data. The calculator is freely available at https:\/\/diuresis.umw.edu.pl.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag185","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:50:33Z","timestamp":1782301833000},"source":"Crossref","is-referenced-by-count":1,"title":["A machine-learning model for accurate diuresis prediction in acute heart failure (DRC-AHF)"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-9963","authenticated-orcid":false,"given":"Gracjan","family":"Iwanek","sequence":"first","affiliation":[{"name":"Clinical Department of Intensive Cardiac Care, Institute of Heart Diseases, Department of Cardiology, Faculty of Medicine, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Jan Mikulicz Radecki University Hospital in Wroclaw ,","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":"Clinical Department of Intensive Cardiac Care, Institute of Heart Diseases, Department of Cardiology, Faculty of Medicine, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Jan Mikulicz Radecki University Hospital in Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amadeusz","family":"Oleszczak","sequence":"additional","affiliation":[{"name":"Office of the Institute of Heart Diseases, Institute of Heart Diseases, Faculty of Medicine, Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iga","family":"Karbowiak","sequence":"additional","affiliation":[{"name":"Ikar Software , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Marciniak","sequence":"additional","affiliation":[{"name":"Department of Drug Form Technology, Faculty of Pharmacy, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-7871","authenticated-orcid":false,"given":"Matteo","family":"Pagnesi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, 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":"Julio","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Cl\u00ednico Universitario, Universitat de Valencia. INCLIVA , Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zymli\u0144ski","sequence":"additional","affiliation":[{"name":"Clinical Department of Intensive Cardiac Care, Institute of Heart Diseases, Department of Cardiology, Faculty of Medicine, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Jan Mikulicz Radecki University Hospital in Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Clinical Department of Intensive Cardiac Care, Institute of Heart Diseases, Department of Cardiology, Faculty of Medicine, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Jan Mikulicz Radecki University Hospital in Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-7722","authenticated-orcid":false,"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[{"name":"Clinical Department of Intensive Cardiac Care, Institute of Heart Diseases, Department of Cardiology, Faculty of Medicine, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Jan Mikulicz Radecki University Hospital in Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"2026091721211891500_xvag185-B1","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.1056\/NEJMra1208943","article-title":"Circulatory shock","volume":"369","author":"Vincent","year":"2013","journal-title":"N Engl J Med"},{"key":"2026091721211891500_xvag185-B2","volume-title":"Human Physiology: An Integrated Approach","author":"Silverthorn Unglaub","year":"2019"},{"key":"2026091721211891500_xvag185-B3","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/EJHF.890","article-title":"Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC heart failure long-term registry","volume":"19","author":"Chioncel","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026091721211891500_xvag185-B4","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1016\/S0025-7125(16)32994-7","article-title":"The clinical use of furosemide and ethacrynic acid","volume":"51","author":"Walker","year":"1967","journal-title":"Med Clin North Am"},{"key":"2026091721211891500_xvag185-B5","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/EURHEARTJ\/EHAB368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026091721211891500_xvag185-B6","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/J.CARDFAIL.2018.02.002","article-title":"Determinants of diuretic responsiveness and associated outcomes during acute heart failure hospitalization: an analysis from the NHLBI heart failure network clinical trials","volume":"24","author":"Kiernan","year":"2018","journal-title":"J Card Fail"},{"key":"2026091721211891500_xvag185-B7","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1002\/EJHF.2852","article-title":"The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. 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