(1777) BAN-ADHF Score to Predict Diuretic Efficiency and Clinical Outcomes in Cardiogenic Shock

Introduction: The BAN-ADHF score utilizes blood urea nitrogen, creatinine, natriuretic peptide, atrial fibrillation, diastolic blood pressure, hypertension, home diuretic dose, and heart failure hospitalization to estimate the probability of low diuretic efficiency on admission. Validation studies for BAN-ADHF noted higher scores were associated with worse outcomes but excluded cardiogenic shock. This study assessed the applicability of low versus high BAN-ADHF scores to predict outcomes in cardiogenic shock.

Methods: Subjects were retrospectively divided into BAN-ADHF < 9 or ≥9 groups prior to receiving their first dose of intravenous (IV) diuretic. Patients 18 years of age and older were included if they received an IV loop diuretic and had standardized shock stages C, D, or E. The primary outcome was diuretic efficiency, defined as total urine output (UOP) per 40 mg IV furosemide equivalent at 24, 48 and 72 hours. Other outcomes included total UOP and weight change at 24, 48 and 72 hours, vasopressor and inotrope initiation, hospital and intensive care unit (ICU) length of stay (LOS), initiation of renal replacement therapy, and in-hospital mortality.

Results: A total of 74 patients were collected from April to November 2023, 37 in each group. Differences in baseline laboratory values and comorbidities between groups were present due to the composition of the BAN-ADHF score. Patients in the BAN-ADHF ≥9 group had decreased diuretic efficiency at 6 hours (1030 vs. 1710 mL, p=0.035), 24 hours (1234 vs. 1752 mL, p=0.005), 48 hours (1122 vs. 1791 mL, p=0.003), and 72 hours (959 vs. 1628 mL, p=0.02). The BAN-ADHF ≥9 group also had greater use of vasopressors (68% vs. 43%, p=0.035) and inotropes (86% vs. 54%, p=0.002), longer hospital LOS (20.3 vs. 11.5 days, p=0.003) and ICU LOS (11 vs. 5.1 days, p< 0.001), and higher in-hospital mortality (32% vs. 8%, p=0.009).

Conclusions: Patients in cardiogenic shock with BAN-ADHF scores ≥9 had decreased diuretic efficiency, longer hospital and ICU LOS, greater use of vasoactives, and higher in-hospital mortality compared to those with BAN-ADHF scores < 9. Thus, BAN-ADHF retains the ability to stratify patients across the heart failure spectrum including cardiogenic shock and can be used to preemptively target patients for aggressive decongestive strategies.