Association between the blood urea nitrogen to creatinine ratio and in‑hospital mortality among patients with acute myocardial infarction: A retrospective cohort study

Abstract

The present study aimed to determine the association between the blood urea nitrogen (BUN) and creatinine (Cr) ratio and in-hospital mortality in patients with acute myocardial infarction (AMI). The present retrospective cohort study included adult patients (≥18 years of age) who were admitted to the intensive care unit (ICU) with a primary diagnosis of AMI. Medical records were obtained from the electronic ICU collaborative research database, which includes data from throughout continental USA. Data included demographic characteristics, vital signs, laboratory tests and comorbidities. The clinical endpoint was in-hospital mortality. The Cox proportional hazards model was used to evaluate the prognostic values of the basic BUN/Cr ratio and the Kaplan-Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. In total, 5,965 eligible patients were included. In the Cox regression analysis, after being adjusted for age, sex, ethnicity and other confounding factors, the BUN/Cr ratio was found to be a significant risk predictor of in-hospital mortality. There was a non-linear relationship between the BUN/Cr ratio and in-hospital mortality after adjusting for potential confounders. A two-piecewise regression model was used to obtain a threshold inflection point value of 18. Furthermore, after adjusting for additional confounding factors (age, sex, ethnicity, BMI, heart rate, oxygen saturation, platelets, total protein, AMI category, heart failure, history of diabetes, history of hypertension, percutaneous coronary intervention, and administration of norepinephrine, dopamine and epinephrine), the BUN/Cr ratio remained a significant predictor of in-hospital mortality (third vs. first tertile: Hazard ratio, 1.50; 95% CI, 1.08-2.09; P<0.05). The Kaplan-Meier curve for tertiles of the BUN/Cr ratio indicated that in-hospital mortality rates were highest when the BUN/Cr ratio was ≥18.34 after adjustment for age, sex and ethnicity (P<0.05). The present findings demonstrated that a higher BUN/Cr ratio was associated with an increased risk of in-hospital mortality in patients with non-ST-segment elevation myocardial infarction. These results support a revision of how the prognosis of patients with AMI is predicted.

Elevated Serum Urea-to-Creatinine Ratio and In-Hospital Death in Patients with Hyponatremia Hospitalized for COVID-19

“…The UCR has been used as an index of a contracted effective circulating volume and/or neurohormonal activation in several areas of clinical research, including ischemic stroke [ 24 , 26 ], heart failure [ 20 , 21 ], acute myocardial infarction [ 22 , 23 ], and subarachnoid hemorrhage [ 27 ]. In these pathological conditions, an elevated UCR value has also been reported as a predictor of poor outcomes.…”

“…Indeed, an elevated BUN/sCr ratio value predicts adverse outcomes both in the general population [ 19 ] and in different clinical scenarios, including congestive heart failure [ 20 , 21 ], acute myocardial infarction [ 22 , 23 ], ischemic stroke [ 24 , 25 , 26 ], and subarachnoid hemorrhage [ 27 ].…”

Blood glucose fluctuation and in-hospital mortality among patients with acute myocardial infarction: eICU collaborative research database

“…In this retrospective cohort study, we included patients from the eICU collaborative research database who diagnosed as AMI according to the International Classification of Diseases (ICD) code (ICD code: 140) at ICU admission and had at least two glucose measurement within 48 hours after ICU admission. The following exclusion criteria were used: (1)…”

“…Acute myocardial infarction (AMI) is a fatal disease caused by acute and persistent ischemia and hypoxia of coronary arteries, resulting in high morbidity and mortality rates [1]. Exploring simple biomarkers is crucial for assessing the risk of in-hospital mortality in patients with AMI.…”

“…A rising body of studies has suggested that elevated glucose levels at admission are frequently observed in patients with AMI, which have also been linked to a poorer prognosis during hospitalization and post-discharge [1][2][3]. In the study of Ferreira et al, they concluded that admission hyperglycemia was associated with higher all-cause mortality in patients with AMI, regardless of previous diabetic status [4].…”