Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023, 167(1):24-29 | DOI: 10.5507/bp.2022.015

Blood urea nitrogen - independent marker of mortality in sepsis

Martin Harazim1, 4, 5, Kaiquan Tan2, Marek Nalos1, 2, 3, Martin Matejovic1, 4
1 ICU, Department of Internal Medicine I, Faculty of Medicine, Charles University and University Hospital Pilsen, Czech Republic
2 Nepean Clinical School, Sydney Medical School and University of Sydney Penrith, Australia
3 Department of Intensive Care Medicine, Nepean Hospital Penrith, Australia
4 Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Czech Republic
5 Department of Gastroenterology and Internal Medicine, Masaryk University and University Hospital Brno, Czech Republic

Background: This retrospective study examines the relationship between admission Blood Urea Nitrogen (BUN) levels and clinical outcomes in patients with sepsis from two separate cohorts in the Czech Republic and the United States.

Methods: The study included 9126 patients with sepsis between January 2014 and December 2018. Kaplan-Meier survival curves and Cox regression were used to analyse the data. An optimal cut-off was calculated by means of the Youden-Index.

Results: BUN at ICU admission was categorized as 10-20, 20-40 and >40 mg/dL. Comparing the group with the highest BUN levels to the one with lowest levels, we found HR for 28 days mortality 2.764 (CI 95% 2.37-3.20; P<0.001). We derived an optimal cut-off for prediction of 28 days mortality of 23 mg/dL. The association between BUN and 28 days mortality remained significant after adjusting for potential confounders - for APACHE IV (HR 1.374; 95%CI 1.20-1.58; P<0.001), SAPS2 (HR 1.545; 95%CI 1.35-1.77; P<0.001), eGFR (HR 1.851; 95%CI 1.59-2.16; P<0.001) and several other variables in an integrative model.

Conclusions: Our findings support the BUN level as an independent and easily available predictor of 28 days mortality in septic critically ill patients admitted to an ICU.

Keywords: BUN, mortality, sepsis, big data, urea

Received: January 4, 2022; Revised: March 7, 2022; Accepted: March 17, 2022; Prepublished online: March 30, 2022; Published: March 15, 2023  Show citation

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Harazim, M., Tan, K., Nalos, M., & Matejovic, M. (2023). Blood urea nitrogen - independent marker of mortality in sepsis. Biomedical papers, 167(1), 24-29. doi: 10.5507/bp.2022.015
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    References

    1. Akhter MW, Aronson D, Bitar F, Khan S, Singh H, Singh RP, Burger AJ, Elkayam U. Effect of elevated admission serum creatinine and its worsening on outcome in hospitalized patients with decompensated heart failure. Am J Cardiol 2004;94:957-60. Go to original source... Go to PubMed...
    2. Filippatos G, Rossi J, Lloyd-Jones DM, Stough WG, Ouyang J, Shin DD, O'Connor C, Adams KF, Orlandi C, Gheorghiade M. Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study. J Card Fail 2007;13:360-64. Go to original source... Go to PubMed...
    3. Liu J, Sun LL, Wang J, Ji G. Blood urea nitrogen in the prediction of in-hospital mortality of patients with acute aortic dissection. Cardiol J 2018;25:371-76. Go to original source... Go to PubMed...
    4. Faisst M, Wellner UF, Utzolino S, Hopt UT, Keck T. Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis. J Crit Care 2010;25:105-11. Go to original source... Go to PubMed...
    5. Gary T, Pichler M, Schilcher G, Hafner F, Hackl G, Rief P, Eller P, Brodmann M. Elevated blood urea nitrogen is associated with critical limb ischemia in peripheral arterial disease patients. Medicine 2015;94(24):e948. doi: 10.1097/MD.0000000000000948 Go to original source... Go to PubMed...
    6. Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 2004;116:466-73. Go to original source... Go to PubMed...
    7. Tatlisu MA, Kaya A, Keskin M, Avsar S, Bozbay M, Tatlisu K, Eren M. The association of blood urea nitrogen levels with mortality in acute pulmonary embolism. J Crit Care 2017;39:248-53. Go to original source... Go to PubMed...
    8. Arihan O, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, Masyuk M, Lauten A, Schulze PC, Hoppe UC. Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU. PloS one 2018;13:e0191697. Go to original source... Go to PubMed...
    9. Beier K, Eppanapally S, Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Elevation of BUN is predictive of long-term mortality in critically ill patients independent of'normal'creatinine. Crit Care Med 2011;39:305. Go to original source... Go to PubMed...
    10. Sullivan DH, Sullivan SC, Bopp MM, Roberson PK, Lensing SY. BUN as an independent predictor of post-hospital-discharge mortality among older veterans. J Nutr Health Aging 2018;22:759-65. Go to original source... Go to PubMed...
    11. Kirtane AJ, Leder DM, Waikar SS, Chertow GM, Ray KK, Pinto DS, Karmpaliotis D, Burger AJ, Murphy SA, Cannon CP, Braunwald E, Gibson CM. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates J Am Coll Cardiol United States 2005:45(11):1781-786. doi: 10.1016/j.jacc.2005.02.068 Go to original source... Go to PubMed...
    12. Kazory A. Emergence of Blood Urea Nitrogen as a Biomarker of Neurohormonal Activation in Heart Failure. Am J Cardiol 2010;106:694-700. Go to original source... Go to PubMed...
    13. Gunst J, Kashani KB, Hermans G. The urea-creatinine ratio as a novel biomarker of critical illness-associated catabolism. Intensive Care Med 2019;45:1813-815. Go to original source... Go to PubMed...
    14. Pollard TJ, Johnson AEW, Raffa JD, Celi LA, Mark RG, Badawi O. The eICU Collaborative Research Database, a freely available multi-center database for critical care research. Sci Data 2018;5:180178. Go to original source... Go to PubMed...
    15. Wang T, Derhovanessian A, De Cruz S, Belperio JA, Deng JC, Hoo GS. Subsequent infections in survivors of sepsis: epidemiology and outcomes. J Intensive Care Med 2014;29:87-95. Go to original source... Go to PubMed...
    16. Gomes DA, de Almeida Beltrão RL, de Oliveira Junior FM, da Silva Junior JC, de Arruda EPC, Lira EC, da Rocha MJA. Vasopressin and copeptin release during sepsis and septic shock. Peptides 2021;136:170437. Go to original source... Go to PubMed...
    17. Kotecha A, Vallabhajosyula S, Coville HH, Kashani K. Cardiorenal syndrome in sepsis: A narrative review. J Crit Care 2018;43:122-27. Go to original source... Go to PubMed...
    18. Chua HR, Puthucheary ZA. Amino Acid Turnover, Protein Metabolism, and Nitrogen Balance in Acute Kidney Injury. In: Ronco C, Bellomo R, Kellum JA, Ricci Z, editors. Critical Care Nephrology. Third Edition. Elsevier; 2017: p 434-442. Go to original source...
    19. Gleeson PJ, Crippa IA, Mongkolpun W, Cavicchi FZ, Van Meerhaeghe T, Brimioulle S, Taccone FS, Vincent JL. Creteur J. Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients. Crit Care Med 2019;47(2):152-58. Go to original source... Go to PubMed...
    20. Chung KS, Song JH, Jung WJ, Kim YS, Kim SK, Chang J, Park MS. Implications of Plasma Renin Activity and Plasma Aldosterone Concentration in Critically Ill Patients with Septic Shock. Korean J Crit Care Med 2017;32(2):142-53. doi: 10.4266/kjccm.2017.00094 Go to original source... Go to PubMed...
    21. Gregoriano C, Molitor A, Haag E, Kutz A, Koch D, Haubitz S, Conen A, Bernasconi L, Hammerer-Lercher A, Fux CA, Mueller B, Schuetz P. Activation of vasopressin system during COVID-19 is associated with adverse clinical outcomes: an observational study. J Endocr Soc 2021;5(6):bvab045. doi: 10.1210/jendso/bvab045 Go to original source... Go to PubMed...
    22. Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med 2020;46(4):637-53. doi: 10.1007/s00134-020-05944-4 Go to original source... Go to PubMed...
    23. Haines RW, Zolfaghari P, Wan Y, Pearse RM, Puthucheary Z, Prowle JR. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma. Intensive Care Med 2019;45(12):1718-731. doi: 10.1007/s00134-019-05760-5 Go to original source... Go to PubMed...
    24. Gottlieb SS. Dead is dead-artificial definitions are no substitute. Lancet 1997;349(9053):662-3. doi: 10.1016/S0140-6736(97)22010-6 Go to original source... Go to PubMed...

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