{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:08Z","timestamp":1760146868855,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Postoperative fluid overload is associated with increased mortality and morbidity in infants with congenital heart disease (CHD). Loop diuretics, such as furosemide, are commonly used to prevent fluid overload in the postoperative period. This study aimed to investigate the effect of postoperative albumin levels on the efficacy of furosemide after surgery in infants with CHD. From 1 January 2017 to 31 December 2022, postoperative albumin levels, total furosemide doses, and three-day postoperative diuresis levels were retrospectively analyzed in 186 patients aged 0\u20131 years who underwent cardiopulmonary bypass at the Pediatric Intensive Care Unit, Diyarbak\u0131r Gazi Ya\u015fargil Training and Research Hospital. Demographic and clinical parameters, along with urine output in the first 6 h, first 24 h, 24\u201348 h, and 48\u201372 h postoperatively, were recorded. Patients were divided into two groups based on their albumin levels: normal albumin (\u226530 g\/dL) and hypoalbuminemia (&lt;30 g\/dL). A common protein interaction network for albumin and furosemide was constructed using Cytoscape software (version 3.10.2). Of the 186 patients, 79 (42.5%) were male and 107 (57.5%) were female, with a median age of 97.5 days (range 1\u2013360 days). Furosemide doses were higher in hypoalbuminemic patients on postoperative days 1 and 2 compared to normoalbuminemic patients. On postoperative day 1, hypoalbuminemia was more prevalent in patients with oliguria, whereas normoalbuminemia was significantly higher in patients with normouria and polyuria. Furosemide doses were significantly higher in patients with oliguria than in those with normouria in the first 6 h and lower in patients with polyuria compared to those with normouria. A positive correlation was observed between albumin levels and furosemide efficacy on postoperative day 2. Additionally, a positive correlation existed between albumin levels on postoperative day 1 and urine output in the first 6 and 24 h postoperatively. Furosemide efficacy and urine output were positively correlated in the postoperative period. Mortality risk was significantly higher in hypoalbuminemic patients on postoperative days 1 and 2, as well as in patients with oliguria in the first 6 and 24 h postoperatively. Network analysis revealed that albumin was directly involved in furosemide\u2019s target network, along with six other proteins within the common interaction network. Diuresis levels were significantly lower in hypoalbuminemic patients. We suggest that the effectiveness of furosemide is reduced because it cannot bind to albumin at sufficient levels. The effective management of albumin levels may enhance furosemide efficacy and improve postoperative outcomes in infants with CHD.<\/jats:p>","DOI":"10.3390\/life14121679","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T08:56:32Z","timestamp":1734512192000},"page":"1679","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Postoperative Albumin Levels on Furosemide Efficacy in Infants with Congenital Heart Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9056-144X","authenticated-orcid":false,"given":"Ay\u015feg\u00fcl","family":"A\u015f\u0131r","sequence":"first","affiliation":[{"name":"Clinics of Pediatrics, Gazi Ya\u015fargil Training and Research Hospital, 21090 Diyarbak\u0131r, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bedri","family":"Aldudak","sequence":"additional","affiliation":[{"name":"Clinics of Pediatric Cardiology, Gazi Ya\u015fargil Training and Research Hospital, 21090 Diyarbak\u0131r, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0027-0532","authenticated-orcid":false,"given":"Nil\u00fcfer","family":"Matur Okur","sequence":"additional","affiliation":[{"name":"Clinics of Neonatology, Gazi Ya\u015fargil Training and Research Hospital, 21090 Diyarbak\u0131r, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s12013-015-0551-6","article-title":"Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments","volume":"72","author":"Sun","year":"2015","journal-title":"Cell Biochem. Biophys."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.cjcpc.2022.11.007","article-title":"Factors Associated With Acute Kidney Injury After Cardiopulmonary Bypass in Children","volume":"2","author":"Gritti","year":"2023","journal-title":"CJC Pediatr. Congenit. Heart Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S2347","DOI":"10.1016\/j.athoracsur.2006.02.073","article-title":"Characterizing the inflammatory response to cardiopulmonary bypass in children","volume":"81","author":"Kozik","year":"2006","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hayashi, Y., Shimazui, T., Tomita, K., Shimada, T., Miura, R.E., and Nakada, T.A. (2023). Associations between fluid overload and outcomes in critically ill patients with acute kidney injury: A retrospective observational study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-44778-0"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/bja\/85.4.599","article-title":"The role of albumin in critical illness","volume":"85","author":"Nicholson","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1093\/ckj\/sfab194","article-title":"Albumin is an interface between blood plasma and cell membrane, and not just a sponge","volume":"15","author":"Joles","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.SLA.0000055547.93484.87","article-title":"Hypoalbuminemia in acute illness: Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials","volume":"237","author":"Vincent","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2331062","DOI":"10.1080\/0886022X.2024.2331062","article-title":"Cardiopulmonary bypass associated acute kidney injury: Better understanding and better prevention","volume":"46","author":"Yang","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.32677\/IJCH.2018.v05.i01.002","article-title":"Hypoalbuminemia as a marker of adverse outcome in children admitted to pediatric intensive care unit","volume":"5","author":"Kumar","year":"2018","journal-title":"Indian J. Child Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.nut.2004.08.026","article-title":"Serum albumin and clinical outcome in pediatric cardiac surgery","volume":"21","author":"Leite","year":"2005","journal-title":"Nutrition"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gaetani, M., Parshuram, C.S., and Redelmeier, D.A. (2023). Furosemide in pediatric intensive care: A retrospective cohort analysis. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1306498"},{"key":"ref_12","first-page":"154","article-title":"High furosemide dose has detrimental effects on survival of patients with stable heart failure","volume":"56","author":"Kapelios","year":"2015","journal-title":"Hell. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5049\/EBP.2015.13.1.17","article-title":"Loop Diuretics in Clinical Practice","volume":"13","author":"Oh","year":"2015","journal-title":"Electrolyte Blood Press."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1365-2044.2009.06228.x","article-title":"Benefits and risks of furosemide in acute kidney injury","volume":"65","author":"Ho","year":"2010","journal-title":"Anaesthesia"},{"key":"ref_15","first-page":"202","article-title":"Toxicity, side effects, and furosemide interactions in therapy of heart failure patients (systematic review)","volume":"11","author":"Wola","year":"2022","journal-title":"J. Kedokt. Diponegoro (Diponegoro Med. J.)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.ahj.2010.05.032","article-title":"Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization","volume":"160","author":"Tu","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"949","DOI":"10.2215\/CJN.15231121","article-title":"Urine Output Monitoring for the Diagnosis of Early-Onset Acute Kidney Injury in Very Preterm Infants","volume":"17","author":"Parvex","year":"2022","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"622","DOI":"10.3390\/cells4040622","article-title":"Albumin and Furosemide Combination for Management of Edema in Nephrotic Syndrome: A Review of Clinical Studies","volume":"4","author":"Duffy","year":"2015","journal-title":"Cells"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lee, T.H., Kuo, G., Chang, C.-H., Huang, Y.T., Yen, C.L., Lee, C.-C., Fan, P.C., and Chen, J.-J. (2021). Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0260312"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"A\u015f\u0131r, F., \u00d6zalp, Z., Y\u00fclek, \u00d6.U., Erdemci, F., Korak, T., and Ta\u015f, F. (2024). CITED1 expression in odontogenic cysts. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04413-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1093\/bioinformatics\/btz931","article-title":"Bioinformatics tools for high-throughput data analysis","volume":"36","author":"Ge","year":"2020","journal-title":"Bioinformatics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ccell.2005.08.006","article-title":"Management of the pediatric postoperative cardiac surgery patient","volume":"17","author":"Beke","year":"2005","journal-title":"Crit. Care Nurs. Clin. N. Am."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13054-014-0724-5","article-title":"Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac surgery: A randomized controlled trial","volume":"19","author":"Ricci","year":"2015","journal-title":"Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00003246-199201000-00010","article-title":"Comparison of continuous versus intermittent furosemide administration in postoperative pediatric cardiac patients","volume":"20","author":"Singh","year":"1992","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Oster, H.S., Dolev, Y., Kehat, O., Weis-Meilik, A., and Mittelman, M. (2022). Serum Hypoalbuminemia Is a Long-Term Prognostic Marker in Medical Hospitalized Patients, Irrespective of the Underlying Disease. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051207"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ejim.2006.09.020","article-title":"The syndrome of rhabdomyolysis: Pathophysiology and diagnosis","volume":"18","author":"Giannoglou","year":"2007","journal-title":"Eur. J. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1017\/S1047951119000738","article-title":"Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass: A multi-centre retrospective study","volume":"29","author":"Henry","year":"2019","journal-title":"Cardiol. Young"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.4103\/0971-9784.179633","article-title":"Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions","volume":"19","author":"Kapoor","year":"2016","journal-title":"Ann. Card. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s00246-020-02339-6","article-title":"The Utility of Albumin Level as a Marker of Postoperative Course in Infants Undergoing Repair of Congenital Heart Disease","volume":"41","author":"Schiller","year":"2020","journal-title":"Pediatr. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1378\/chest.07-2573","article-title":"Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants","volume":"134","author":"Shi","year":"2008","journal-title":"Chest"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Claure-Del Granado, R., and Mehta, R.L. (2016). Fluid overload in the ICU: Evaluation and management. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0323-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1017\/S1047951121001451","article-title":"A systematic review of the evidence supporting post-operative diuretic use following cardiopulmonary bypass in children with Congenital Heart Disease","volume":"31","author":"Foote","year":"2021","journal-title":"Cardiol. Young"},{"key":"ref_33","first-page":"1047","article-title":"Growth and development in children with congenital heart disease","volume":"92","author":"Hager","year":"2006","journal-title":"Heart"},{"key":"ref_34","first-page":"1103","article-title":"Tweddell Protocols for Management of the Norwood Procedure for Hypoplastic Left Heart Syndrome","volume":"123","author":"Tweddell","year":"2002","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1136\/heartjnl-2015-309069","article-title":"Ventricular arrhythmias and sudden cardiac death in adults with congenital heart disease","volume":"102","author":"Khairy","year":"2016","journal-title":"Heart"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1345\/aph.1C320","article-title":"Combined furosemide and human albumin treatment for diuretic-resistant edema","volume":"37","author":"Elwell","year":"2003","journal-title":"Ann. Pharmacother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1136\/heartjnl-2014-306970","article-title":"Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease","volume":"101","author":"Kempny","year":"2015","journal-title":"Heart"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/12\/1679\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:54:48Z","timestamp":1760115288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/12\/1679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,18]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["life14121679"],"URL":"https:\/\/doi.org\/10.3390\/life14121679","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2024,12,18]]}}}