The main objectives of this study was to estimate the effects of diuretic use during the first 24 hours of an ICU stay on in-hospital mortality and other clinical outcomes including acute kidney injury (AKI) and duration of mechanical ventilation.

Adult patients admitted to medical or cardiac ICUs between 2001 and 2012, excluding those on maintenance dialysis or with ICU length of stay less than 24 hours.

13,589 patients were included in the study. 2,606 with and 10,983 without early diuretic use (loop diuretic exposure during the first 24 hr of an ICU stay). Propensity score matching generated 2,523 pairs with well-balanced baseline characteristics.

Early diuretic use in the ICU is common. No evidence of benefit to diuretic use in the first 24 hours after ICU admission, whether examined in the cohort overall or in subgroups with heart failure, CKD, or ALI that might be expected to derive greater benefit from early diuretic use.

Consistent and highly statistically significant adverse effects-AKI and electrolyte abnormalities—of early diuretic use were found.

The results suggest that diuretics may not have a net benefit on the first day of ICU admission.

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