Blood Urea Nitrogen in the Early Assessment of Acute Pancreatitis

Wu, Bechien U.; Bakker, Olaf J.; Papachristou, Georgios I.; Besselink, Marc G.; Repas, Kathryn; Santvoort, Hjalmar C. van; Muddana, Venkata; Singh, Vikesh K.; Whitcomb, David C.; Gooszen, Hein G.; Banks, Peter A.

doi:10.1001/archinternmed.2011.126

Cited by 161 publications

(137 citation statements)

References 36 publications

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“…It also showed that BUN is the most accurate predictor of in-hospital mortality when compared with other routine laboratory parameters such as calcium, hemoglobin, creatinine, white blood cell count, and glucose levels ( 16 ). Th e follow-up report, conducted by the same collaborative centers as the present study, suggested that BUN ≥20 mg/dl was associated with a 4.6 odds ratio for mortality ( 14 ).…”

Section: Discussionsupporting

confidence: 64%

“…Th e Markers of Severity in Acute Pancreatitis (MOSAP) cohort was developed at BWH, in Boston, MA ( 14,24 ). AP patients directly admitted or transferred to BWH from 2005 through 2009 were prospectively recruited.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

“…BUN and hematocrit values were rounded to the tenth decimal and creatinine values to the hundredth decimal. BUN, hematocrit, and creatinine were considered elevated when exceeding thresholds of 20 mg/dl ( 14 ), 44% ( 15,18 ),…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

“…Such laboratory parameters have great potential, because they are readily available, inexpensive, and have standardized reference ranges. Multiple studies have reported a signifi cant association between serum levels of BUN, hematocrit, and creatinine on admission and their changes over 24-48 h with severe disease (14)(15)(16)(17)(18)(19)(20)(21)(22). However, the majority of these studies are limited by small sample size, retrospective nature, and use of variable outcomes of severity.…”

mentioning

confidence: 99%

“…However, the majority of these studies are limited by small sample size, retrospective nature, and use of variable outcomes of severity. In 2011, BUN was shown to be an accurate predictor of mortality in a large, prospective study from the United States and Th e Netherlands, in which an admission BUN ≥20 mg/dl was associated with a 4.6 odds ratio (OR) for mortality ( 14 ).…”

mentioning

confidence: 99%

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Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

134

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Section: Discussionsupporting

confidence: 64%

Section: Study Design and Patient Populationmentioning

confidence: 99%

Section: Study Design and Patient Populationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

134

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Acute Pancreatitis

Mederos

Reber

Girgis

2021

JAMA

494

321

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cute pancreatitis is one of the most common gastrointestinal conditions that results in hospital admission in the United States. The incidence of acute pancreatitis is estimated at 110 to 140 per 100 000 population, with an estimated more than 300 000 US emergency department visits per year. 1,2 Admissions due to acute pancreatitis have increased from 9.48 cases per 1000 hospitalizations in 2002 to 12.19 in 2013, with a median hospital cost of nearly $7000 per hospitalization. 3,4 Acute pancreatitis is a complex disease with a variable course that is often difficult to predict early in its development (eBox in the Supplement). Approximately 80% of patients develop mild to moderately severe disease (absence of organ failure >48 hours). 5,6 However, one-fifth of patients develop severe disease, with a mortality rate of approximately 20%. 5,7 The purpose of this review is to summarize evidence regarding the recognition of disease severity, fluid and nutrition management, and risk-reduction methods for the prevention of recurrent disease. MethodsPubMed and the Cochrane databases were searched for Englishlanguage studies published from January 2009 through August 2020 for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. Manual searches were performed of the references of selected articles, reviews, metaanalyses, and practice guidelines. Select studies prior to 2009 were included for historical context. Emphasis was given to RCTs and metaanalyses. All publications and citations included were mutually agreed on by the authors and selected for clinical importance and relevance with consideration to the general medical readership of JAMA. Sixty-six articles were included, which contained 8 RCTs, 12 meta-analyses, and 5 clinical guidelines. Pathogenesis and EtiologyAcute pancreatitis is characterized by damage to the acinar cells, the functional units of the exocrine pancreas, precipitating inappropriate release and activation of trypsinogen to trypsin within the acini. This triggers the activation of other digestive enzymes, the kinin system, and the complement cascade resulting in autodigestion of the pancreatic parenchyma. 8,9 Pancreatic duct obstruction (eg, gallstone pancreatitis) is one of the more common causes of acinar damage, causing an increase in ductal pressure, interstitial edema, and accumulation of enzyme-rich fluid within the pancreatic tissue. 10 Alternatively, primary acinar injury may be caused by a variety of other factors, such as calcium, which regulates trypsin activation. Inappropriate release of IMPORTANCE In the United States, acute pancreatitis is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year. Outcomes from acute pancreatitis are influenced by risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies, which are the subject of this review.OBSERVATIONS MEDLINE was searched via PubMed as was the Cochrane data...

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