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We are interested in the recently published article about the effect of furosemide on the outcomes of patients with acute renal injury (AKI) [1], because the result seems against to the current guidelines [2]. AKI is commonly faced by the intensivists and its effects on mortality have drawn great attention recently. Zhao and his colleagues explored the effect of furosemide on the outcomes of critically ill patients with AKI in a real-word dataset, the MIMIC III database. They found the furosemide administration was associated with better short-term survival, especially in the AKI stages 2–3. However, the dataset they used in the analysis is single-center. We notice that another real-world database, the eICU database, which has larger size of data (200,859 patients) and more contributing centers (335 units at 208 hospitals), has been available to the world [3]. We reproduced the main analysis of Zhao’s study in the eICU database to give more evidence for the real-world research. The main results for outcomes are presented in Table 1. Some results are similar with Zhao’s study [1]: the furosemide group has a higher recovery rate and longer hospital and ICU stay. However, a reduction in inhospital mortality for the furosemide group only exists in the dataset after propensity score matching (PSM) and under the method of Cox regression (HR 0.92; 95% CI 0.85–0.99; p = 0.03). For subgroup analysis, furosemide reduces mortality only in AKI stages 2 and 3, but not in any of AKI or AKI stages. Up to now, the main viewpoint is that diuretics including furosemide do not improve survival of AKI patients. The protective effect by improved renal function observed in some studies [1, 4] (include Zhao’s and ours) may be covered by the adverse events, such as electrolyte abnormalities [5]. Our study supports no benefit for furosemide on in-hospital mortality of AKI patients, despite a significant p value in the post-PSM dataset under the method of Cox regression (Table 1). Most of the studies use logistic regression to evaluate in-hospital mortality, because longer hospital stay for acute condition is not like longer follow-up time in chronic condition and may implicate bad outcomes. However, since the in-hospital mortality nearly doubles in the non-diuretic group comparing to the furosemide group in Zhao’s study (21.7% vs 12.7%), the debate of this issue still exists and needs more well-designed research.

Do critically ill patients with AKI benefit from furosemide? Further real-word evidence from a large multi-center database