Association between BUN/creatinine ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome: a single-centre retrospective cohort from the MIMIC database

Abstract

ObjectiveRecent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess the association between BUN/Cr ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome (ARDS).DesignA retrospective cohort study.Setting and participants1034 patients were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database.Primary and secondary outcome measuresThe primary outcome of the study was in-hospital mortality, defined by the vital status at the time of hospital discharge (ie, survivors and non-survivors).ResultsOf the total patients, 191 (18.5%) died in hospital. The median follow-up duration was 16.0 (8.3–26.6) days. The results showed that high level of BUN/Cr ratio was significantly associated with an increased risk of in-hospital mortality (15.54–21.43: HR=2.00, 95% CI: (1.18 to 3.38); >21.43: HR=1.76, 95% CI: (1.04 to 2.99)) of patients with trauma-related ARDS. In patients with trauma-related ARDS that aged ≥65 years old, male and female, Onychomycosis Severity Index (OSI)>98, Revised Trauma Score (RTS)>11, Simplified Acute Physiology Score II (SAPS-II)>37 and sequential organ failure assessment (SOFA) scores≤7, BUN/Cr ratio was also related to the increased risk of in-hospital mortality (all p<0.05). The predictive performance of BUN/Cr ratio for in-hospital mortality was superior to BUN or Cr, respectively, with the area under the curve of receiver operator characteristic curve at 0.6, and that association was observed in age, gender, OSI, RTS, SAPS-II and SOFA score subgroups.ConclusionBUN/Cr ratio may be a potential biomarker for the risk of in-hospital mortality of trauma-related ARDS, which may help the clinicians to identify high-risk individuals and to implement clinical interventions.

Blood urea nitrogen to creatinine ratio is associated with in-hospital mortality in critically ill patients with venous thromboembolism: a retrospective cohort study

“…The BCR is a straightforward and readily obtainable measure, as it relies solely on venous blood samples in clinical settings. Previous studies have reported an association between the BCR and in-hospital mortality in various diseases (17)(18)(19)(20). BCR, a biomarker of neurohormonal activity, has been associated with poor prognosis in patients with acute heart failure and is an independent predictor of all-cause mortality (31).…”

“…Their investigation revealed that a higher BUN/Cr ratio served as an independent prognostic indicator for both the COVID-19 severity and patient outcomes related to survival. Ma et al ( 20 ) conducted a recent investigation to elucidate the association between the BUN/Cr ratio and in-hospital mortality among patients diagnosed with trauma-induced acute respiratory distress syndrome. Their findings revealed a statistically significant correlation between elevated BUN/Cr ratios and an increased risk of death within the hospital setting for these patients.…”

“…Therefore, the BUN to creatinine ratio (BCR) is more valuable than either BUN or creatinine alone, as it is less prone to fluctuations and better reflects kidney function. The BCR is a useful predictor of outcomes in various diseases, and a high BCR is linked to increasing in-hospital mortality in critically ill patients, including those with septic shock ( 17 ), acute myocardial infarction ( 18 ), cerebral infarction ( 19 ), acute respiratory distress syndrome ( 20 ), cardiogenic shock ( 21 ), and COVID-19 ( 22 ). In patients with VTE, cardiorenal function and neurohumoral regulation are impaired due to various factors such as systemic hypoxia, activation of chemoreflex, hypercapnia, and inflammatory state, leading to elevated BUN and creatinine levels ( 23 – 27 ).…”