The Effects of Furosemide usage on Organ System Failure Status based on Modified Sequential Organ Failure Assessment Score in Critically ill Patient

Abstract

Objectives: Eighty-six percent of patients administrated with intravenous fluid resuscitation had positive fluid accumulation. This resulted in fluid overload in 35% of all ICU patients in 2009–2012. Then, the worst consequence is multi-organs failures. Thus, one of the treatments is pharmacological diuresis to solve physiological problems. Despite of its adverse effects and fluid balance decrement on the hypoperfused organ, the organ failure resolution of furosemide usage has not been proven through any research. Hence, a research which analyzed the correlation of organ system failure status based on modified sequential organ failure assessment (MSOFA) score with furosemide usage on intensive care patient and their demographics data has been conducted. Material and Methods: The research design was a retrospective cohort which analyzed 194 subjects through ICU medical records selected by consecutive sampling method. Data of furosemide usage and MSOFA score changes were recorded. Thereafter, Chi-square test was conducted to analyze the data. Moreover, characteristics of subjects were also recorded and analyzed in this study. Results: Based on the characteristics of subjects analysis, significant factors on furosemide usage (P < 0.05) included total fluid changes, total fluid after therapy, organ system dysfunctions before therapy (including the respiratory and central nervous system), organ system dysfunction after therapy (cardiovascular), and MSOFA score before therapy. Very significant factors (P < 0.001) include total fluid before therapy, organ system dysfunction after therapy (central nervous system), and MSOFA score after therapy. There was a significant association between worsening organ system failure with furosemide usage on critically ill patients, especially in the cardiovascular and central nervous system. The relative risk result reported that furosemide usage resulted in higher MSOFA score 1.271 times more than those patients with no furosemide diuresis usage (95% CI 1.108– 1.458). Furosemide usage in this research worsens organ dysfunction, especially in cardiovascular and central nervous systems. Conclusion: The furosemide usage worsens the organ failure based on MSOFA score. Furosemide therapy should be individually adjusted, especially in those who have respiration, cardiovascular, and central nervous system dysfunction.