Diuretic Resistance and the Efficacy of Hydrochlorothiazide in Acute Decompensated Heart Failure: A Post-Hoc Analysis of the CLOROTIC Trial
Bibliographic record
Abstract
Abstract Aims Diuretic resistance (DR) in acute decompensated heart failure (ADHF) is associated with poor outcomes. The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) with intravenous furosemide improved weight loss in ADHF. We assessed performance of the BAN-ADHF DR score and association between DR risk and HCTZ treatment response. Methods and results We included participants from CLOROTIC and assessed BAN-ADHF performance in identifying lowest net diuretic efficiency phenogroup, as identified with a random forest classifier. Participants were stratified by the BAN-ADHF score (≤12: low DR risk and >12: high DR risk) to compare treatment effect of HCTZ versus placebo across DR risk. Outcomes were weight change and area under the curve (AUC) of dyspnoea visual analogue scale (VAS) at 72/96 h, fluid loss at 72 h, and 30/90-day mortality. Among 220 participants (50.9% male, mean age 83 years), the BAN-ADHF score demonstrated good performance in identifying low net diuretic efficiency phenogroup (area under the receiver operating characteristic curve: 0.81). Weight change and VAS AUC at 72 h was similar across DR risk strata, however, participants with high versus low DR risk had lower fluid loss at 72 h (686 vs. 889 ml, p = 0.003), higher 30-day (11.1% vs. 2.4%, p = 0.035) and 90-day mortality (23.0% vs. 10.6%, p = 0.033). The treatment effect of HCTZ (vs. placebo) on weight change was similar across DR risk (pint = 0.75 at 72 h; pint = 0.50 at 96 h). DR risk modified efficacy of HCTZ versus placebo on dyspnoea VAS, with high (vs. low) DR risk having attenuated improvement at 72 h (−236 vs. 476 mm; pint = 0.03) and 96 h (−400 vs. 777 mm; pint = 0.001). Conclusions The BAN-ADHF score demonstrated good performance in identifying DR, and high DR risk was associated with worse outcomes. HCTZ treatment response on weight loss was similar across DR risk, but improvement in dyspnoea with HCTZ was attenuated in high DR risk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".