Does Blood Urea Nitrogen Level Predict Severity and High-Risk Endoscopic Lesions in Patients with Nonvariceal Upper Gastrointestinal Bleeding?

Al-Naamani, Khalid; Al-Zadjali, Nabil; Barkun, Alan N.; Fallone, Carlo A

doi:10.1155/2008/207850

Cited by 21 publications

(10 citation statements)

References 20 publications

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“…This association of BUN with mortality is in accordance to literature: Regardless of admission diagnosis such as acute pulmonary embolism [ 12 ], acute pancreatitis [ 13 ], acute decompensated heart failure [ 14 ], upper gastrointestinal bleeding [ 15 , 16 ] or ventilation failure which requires mechanical aid [ 17 ] high admission BUN levels were reported to be associated adverse outcome. Our study supports this notion in critically ill medical patients.…”

Section: Discussionsupporting

confidence: 89%

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

et al. 2018

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PurposeBlood urea nitrogen (BUN) was reported to be associated with mortality in heart failure patients. We aimed to evaluate admission BUN concentration in a heterogeneous critically ill patient collective admitted to an intensive care unit (ICU) for prognostic relevance.MethodsA total of 4176 medical patients (67±13 years) admitted to a German ICU between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. Association of admission BUN and both intra-hospital and long-term mortality were investigated by Cox regression. An optimal cut-off was calculated by means of the Youden-Index.ResultsPatients with higher admission BUN concentration were older, clinically sicker and had more pronounced laboratory signs of multi-organ failure including kidney failure. Admission BUN was associated with adverse long-term mortality (HR 1.013; 95%CI 1.012–1.014; p<0.001). An optimal cut-off was calculated at 28 mg/dL which was associated with adverse outcome even after correction for APACHE2 (HR 1.89; 95%CI 1.59–2.26; p<0.001), SAPS2 (HR 1.85; 95%CI 1.55–2.21; p<0.001) and several parameters including creatinine in an integrative model (HR 3.34; 95%CI 2.89–3.86; p<0.001). We matched 614 patients with admission BUN >28 mg/dL to case-controls ≤ 28mg/dL corrected for APACHE2 scores: BUN above 28 mg/dL remained associated with adverse outcome in a paired analysis with the difference being 5.85% (95%CI 1.23–10.47%; p = 0.02).ConclusionsHigh BUN concentration at admission was robustly associated with adverse outcome in critically ill patients admitted to an ICU, even after correction for co-founders including renal failure. BUN might constitute an independent, easily available and important parameter for risk stratification in the critically ill.

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Section: Discussionsupporting

confidence: 89%

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

et al. 2018

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“…BUN itself predicts the severity of upper GI bleed bleeding. 20 In the present study, the mean platelet count was 1,37000 at the time of presentation. In a study by The mean Rockall score for intermittent regimen was 3.88 and mean Rockall score for the continuous regimen was 3.88 both being similar, and difference was statistically insignificant.…”

Section: Discussionsupporting

confidence: 42%

A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

et al. 2018

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Background: UGI bleeding is defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Intermittent dosage regimen IV bolus and high dose IV continuous infusion forms helps in achieving and maintaining this pH goal of more than 6 which forms optimal environment for peptic ulcer healing and clot stabilization to occur. Theoretically, high-dose IV continuous infusion should provide the most potent acid suppression. Aims and objective was to compare the efficacy of intermittent dose of pantoprazole given for 3 days i.e. 40mg intravenous twice a day versus continuous infusion dose of pantaprazole i.e. 80mg intravenous bolus followed by 8mg/hour for first 72hours in the treatment of UGI bleed.Methods: Patients of UGI bleed were randomly assigned to receive either continuous or intermittent regimen of pantaprazole as a part of management.Results: Among 118 patients of peptic ulcer disease, 7 patients had rebleed and 111 patients had no rebleed.3 patients among 59 patients who received continuous regimen and 4 patients among 59 patients who received intermittent regimen had rebleed with a total of 7 patients among 118 patients. Among 118 patients only 2 patients of the total had need for surgery for stabilization. Among 59 patients who received continuous regimen 2 patients needed surgery while none of the 59 patients who received intermittent regimen needed for surgery. Of the 118 patients 10 patients had mortality at the end of 30 day period. In both the regimes 5 patients died.Conclusions: The difference between Rockall score of the intermittent and continuous regimen group was statistically insignificant. The incidence of rebleed was 5.1 % for continuous and 6.7% for intermittent regimen which was statiscally insignificant. The incidence of mortality was similar 8.5%in both regimen.

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“…Ischemic change in the liver at 48 h in SubAB-treated mice was consistent with excessive bleeding and circulatory compromise, as were the elevations of AST and ALT. Elevated BUN levels were consistent with gastrointestinal bleeding due to ingested blood protein or kidney failure [26]. A coagulation disorder was also observed at 48 h in SubAB-treated mice.…”

Section: Discussionmentioning

confidence: 98%

Fatal hemorrhage induced by subtilase cytotoxin from Shiga-toxigenic Escherichia coli

Furukawa

Yahiro

Tsuji³

et al. 2011

Microbial Pathogenesis

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Subtilase cytotoxin (SubAB) is an AB5 type toxin produced by a subset of Shiga-toxigenic Escherichia coli. The A subunit is a subtilase-like serine protease and cleaves an endoplasmic reticulum chaperone BiP. The B subunit binds to a receptor on the cell surface. Although SubAB is lethal for mice, the cause of death is not clear. In this study, we demonstrate in mice that SubAB induced small bowel hemorrhage and a coagulopathy characterized by thrombocytopenia, prolonged prothrombin time and activated partial thromboplastin time. SubAB also induced inflammatory changes in the small intestine as detected by 18F-Fluoro-2-deoxy-D-glucose positron emission tomography imaging and histochemical analysis. Using RT-PCR and ELISA, SubAB was shown to increase interleukin-6 in a time-dependent manner. Thus, our results indicate that death in SubAB-treated mice may be associated with severe inflammatory response and hemorrhage of the small intestine, accompanied by coagulopathy and IL6 production.

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Does Blood Urea Nitrogen Level Predict Severity and High-Risk Endoscopic Lesions in Patients with Nonvariceal Upper Gastrointestinal Bleeding?

Abstract: In patients with nonvariceal UGIB, the BUN level at initial presentation is a weak predictor of the severity of UGIB as defined by ICU admission, but is not helpful in identifying patients with a HRL.

Cited by 21 publications

References 20 publications

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

Fatal hemorrhage induced by subtilase cytotoxin from Shiga-toxigenic Escherichia coli

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