Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis

Abstract

BackgroundThe mortality rate of patients with heart failure (HF) remains high, and when heart failure occurs, blood urea nitrogen (BUN) is involved in the perfusion of renal blood flow. Some studies have shown an association between heart failure prognosis and blood urea nitrogen, but the results of some other studies were inconsistent. Therefore, we conducted a comprehensive meta-analysis to investigate the value of BUN on the prognosis of patients with heart failure.MethodsA computerized systematic search of all English literature was performed in four databases, PubMed, Cochrane, Embase and Web of Science, from their inception to May 2022. The data of BUN were classified into continuous and categorical variables after passing the inclusion and exclusion criteria. The BUN data of both types were extracted separately into stata15.0 for statistical analysis.ResultsA total of 19 cohort studies involving 56,003 patients were included. When BUN was used as a categorical variable, the risk of death in heart failure was 2.29 times higher for high levels of BUN than for low levels of BUN (RR = 2.29, 95% CI:1.42–3.70, P < 0.001). The results showed statistical significance in multifactorial and univariate groups, the prospective cohort, and European and Asian groups. When BUN was used as a continuous variable, the risk of death in heart failure was 1.02 times higher for each unit increase in BUN (RR = 1.02, 95% CI:1.01–1.03, p < 0.001). Subgroup analysis showed statistical significance in retrospective cohort, American and Asian.ConclusionHigh BUN is an independent predictor of all-cause mortality in heart failure. Lower BUN was associated with better prognosis in patients with heart failure.

Nomogram Model Establishment for Short-Term Survival Prediction in Hypothyroidism Patients with Heart Failure Based on the MIMIC-IV Database

“…And the predictive value of BUN for heart failure remains controversial in the literature. Sachdeva et al 33 found that BUN did not have any predictive value for heart failure prognosis, while Takaya et al reported that BUN was predictive only when combined with renal failure. Therefore, further exploration is necessary to determine whether BUN affects the prognosis of heart failure.…”

Independent prognostic importance of blood urea nitrogen to creatinine ratio in heart failure

“…[5][6][7] However, little is known about the importance of BUN or the BUN/creatinine ratio in the chronic setting where major changes in volume status, and associated peaks of neurohumoral activation, over short periods are less common. 3,8 We have investigated whether the BUN/creatinine ratio has the same independent prognostic value in ambulatory patients and whether this differs between those with HFrEF and HF with preserved ejection fraction (HFpEF) using data from five large randomized trials.…”

“…Particularly, in the acute setting, dehydration, and hypovolaemia, as well as other problems such as upper gastrointestinal bleeding, may lead to greater increases in BUN, relative to creatinine, and in patients hospitalized with worsening HF, elevated BUN and BUN/creatinine ratio is associated with worse outcomes, independently of eGFR or creatinine alone 5–7 . However, little is known about the importance of BUN or the BUN/creatinine ratio in the chronic setting where major changes in volume status, and associated peaks of neurohumoral activation, over short periods are less common 3,8 . We have investigated whether the BUN/creatinine ratio has the same independent prognostic value in ambulatory patients and whether this differs between those with HFrEF and HF with preserved ejection fraction (HFpEF) using data from five large randomized trials.…”

Currently Used Methods to Evaluate the Efficacy of Therapeutic Drugs and Kidney Safety

“…However, blood urea nitrogen (BUN) and serum creatinine (SCr) are not very accurate and specific markers of kidney function in acute coronary syndrome [11]. For instance, the BUN and SCr are not accurate renal function indexes due to the abnormal BUN/SCr ratio observed in patients with heart failure [12]. The levels of the serum biomarkers mentioned above and urine biomarkers among patients with liver failure were affected by numerous factors, including ingestion of creatinine, excretion of drugs, protein intake, sex, and age [13].…”