Blood urea nitrogen variation upon admission and at discharge in patients with heart failure

Abstract

Aims Heart failure (HF) is one of the leading causes for hospitalization and mortality. After first admission with acute decompensated HF, some patients are in high risk for short‐term and long‐term mortality. These patients should be identified, closely followed up, and treated. It has been observed that blood urea nitrogen (BUN) on admission is a predictive marker for short‐term mortality. Recently, it has been shown that higher BUN levels on discharge are also a bad prognostic predictor. However, the prognostic value of BUN alteration during hospital stay was not investigated; therefore, we aimed to investigate the effect of BUN variation during hospitalization on mortality. Methods and results A retrospective study included patients with first hospitalization with the primary diagnosis of HF. The patients were divided into four groups on the basis of the values of BUN on admission and discharge, respectively: normal‐normal, elevated‐normal, normal‐elevated, and elevated‐elevated. Four thousand seven hundred sixty‐eight patients were included; 2567 were male (53.8%); the mean age was 74.7 ± 12.7 years. The 90 day mortality rate in the normal‐normal group was 7% lower than that in the elevated‐normal (14.6%) and normal‐elevated (19.3%) groups; P value < 0.01. The 90 day mortality in the elevated‐elevated group (28.8%) was significantly higher than that in the other groups; P < 0.001. During the 36 month follow‐up, these results are maintained. While sub‐dividing BUN levels into <30, 30–39, and >40 mg/dL, higher BUN levels correlated with higher 90 day mortality rate regardless of creatinine levels, brain natriuretic peptide, or age. Moreover, BUN on admission and on discharge correlated better with mortality than did creatinine and glomerular filtration rate at the same points. Conclusions The BUN both on admission and on discharge is a prognostic predictor in patients with HF; however, patients with elevated levels both on admission and on discharge have the worst prognosis. Moreover, worsening or lack of improvement in BUN during hospitalization is a worse prognostic predictor. To the best of our knowledge, this is the first trial to discuss the BUN change during hospitalization in HF.

Hyponatremia is an independent predictor of emergency department revisits in acute exacerbation of COPD

“…Blood urea nitrogen level at admission is defined as a predictor of worse outcome in heart failure 30 and AECOPD. 31 In parallel, we found higher ED revisit rates with higher urea levels.…”

SOFA score and short-term mortality in acute decompensated heart failure

“…5 Cardiology Department, Rambam Health Care Campus, Haifa, Israel. 6 Internal Medicine Department H, Rambam Health Care Campus, Haifa, Israel. 7 Medicine Department D, Rambam Health Care Campus, Haifa, Israel.…”

“…A number of laboratory markers has been associated with increased risk of short term mortality, Blood Urea Nitrogen (BUN) and natriuretic peptides level both in admission and discharge were associated with increased risk for short term mortality [4][5][6][7] .…”

Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio

“…To the best of our knowledge, no study in the literature has investigated the predictive value of higher urea for the mortality rates of patients who undergo PEG insertion. Nonetheless, some studies have indicated that urea levels can be used to predict shortterm mortality rates in cardiac diseases (19). Moreover, Sbeit et al indicated that creatinine and some other parameters could predict short-term mortality after PEG (20).…”