Blood urea nitrogen to creatinine ratio is associated with in-hospital mortality among critically ill patients with cardiogenic shock

Abstract

BackgroundsAlthough Blood urea nitrogen (BUN) and serum creatinine concentration (Cr) has been widely measured in daily clinical practice, BUN-to-Cr ratio (BCR) for prognosis among patients admitted with cardiogenic shock (CS) remains unknown. The present study was conducted to assess the prognostic effectiveness of BCR on CS.Methods and resultsRecords of data for patients with CS were extracted from public database of the Medical Information Mart for Intensive Care-III (MIMIC-III). The primarily endpoint was in-hospital mortality. We incorporated multivariate Cox regression model and Kaplan–Meier curve to evaluate the relationship between BCR and in-hospital mortality, adjusting for potential confounders. Data of 1137 patients with CS were employed for the final cohort, with 556 in the low BCR (< 20) and 581 in the high BCR (≥ 20) group. In the multivariate Cox model and Kaplan–Meier curve, compared to low BCR, we found high BCR was independently associated with significantly improved in-hospital survival for CS (HR 0.66, 95% CI 0.51–0.84;P < 0.01). The benefit of high BCR on in-hospital survival for CS was remaining among subgroups of acute kidney injury (AKI) and non-AKI.ConclusionsOur analysis indicated that high BCR, as compared to low BCR, was correlated with improved in-hospital survival for participants with CS, with or without AKI. The results need to be proved in large prospective studies.

Blood urea nitrogen and creatinine in in-hospital cardiac arrest patients

“…Dr. Sun et al investigated the prognostic effectiveness of BCR on cardiogenic shock, and the results showed high CBR was correlated with improved in-hospital survival for patients with cardiogenic shock, regardless of the presence or absence of AKI status, as compared to low BCR. 17 Similar to Dr. Sun's study, 17 Dr. Meng's study also could not prove causality. 10 Although Dr. Meng's effort was done on the identification of the critical prognostic factor to predict the neurological outcomes in IHCA patients, many confounding factors and possible biases could not be completely avoided, contributing to the uncertain role of BCR in the prediction of neurological outcomes in patients in IHCA patients after resuscitation.…”

“…Dr. Sun et al investigated the prognostic effectiveness of BCR on cardiogenic shock, and the results showed high CBR was correlated with improved in-hospital survival for patients with cardiogenic shock, regardless of the presence or absence of AKI status, as compared to low BCR. 17 Similar to Dr. Sun’s study, 17 Dr. Meng’s study also could not prove causality. 10…”

Prognostic Impact of Stress Hyperglycemia in Non-Diabetic Patients Treated with Successful Primary Percutaneous Coronary Intervention

“…Other possible direct mechanisms of the prognostic impact of SH may be the consequence of the acute release of catecholamines, cytokines, cortisol, etc., thus leading to oxidative stress, endothelial dysfunction, inflammation, apoptosis, and the state of hypercoagulability, which can affect the size of the infarction despite a good TIMI flow through the IRA [1][2][3][4]6,7,12,14,15,17].…”

“…Stress hyperglycemia (SH) is defined as a transitory increase in the blood glucose level that occurs in critically ill patients in intensive care units [1][2][3][4]. As a stress state, acute myocardial infarction (AMI) can lead to stress hyperglycemia [2,3].…”

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

“…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 ).…”