Prognostic Value of Blood Urea Nitrogen/Creatinine Ratio for Septic Shock: An Analysis of the MIMIC-III Clinical Database

Abstract

Background. Research has previously been done into the risk factors for mortality in septic shock patients. However, there has been no epidemiological study investigating the effect of the blood urea nitrogen/creatinine ratio (BCR) on the prognosis of critically ill septic shock patients. This study is aimed at determining the relationship between BCR and all-cause mortality in adult septic shock patients. Methods. Data were extracted from the MIMIC-III database. The clinical endpoints were 28-, 90-, and 365-day all-cause mortality rates in critically ill septic shock patients. Cox proportional hazards models and subgroup analyses were used to analyze the relationship between BCR quartiles and all-cause mortality in septic shock patients. Receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs) were calculated to evaluate how accurately BCR predicts the mortality of septic shock patients. Results. Among the 2484 septic shock patients extracted from the database, 619, 563, 677, and 625 fell into the first (<14.4 mg/dL), second (≥14.4 mg/dL and <20.0 mg/dL), third (≥20.0 mg/dL and <27.3 mg/dL), and fourth (≥27.3 mg/dL) quartiles of BCR, respectively. Male and white patients accounted for 53.8% (1336 patients) and 74.8% (1857 patients) of the population, respectively. The mean age of the population was 67.7 ± 15.8 years. An inverse M-shaped relationship between BCR and mortality in septic shock patients was identified, with a value of ≥27.3 mg/dL providing the highest risk ( HR = 1.596 , 95% CI: 1.396-1.824, P < 0.001 ). In the Cox regression model adjusted for different confounding variables, BCR values in the fourth quartiles were significantly associated with increased mortality, using the first quartiles as a reference. The areas under the ROC curves (AUCs) for BCR plus the Sequential Organ Failure Assessment (SOFA) score and BCR plus Acute Physiology Score III (APSIII) were 0.694 (95% CI: 0.673-0.716) and 0.724 (95% CI: 0.703-0.744), respectively. Conclusion. An inverse M-shaped curve was determined between BCR and the mortality of septic shock patients. BCR was identified as a readily available and independent prognostic biomarker for septic shock patients, and higher BCRs were associated with increased mortality in these patients.

Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: A retrospective analysis of the fourth-generation Medical Information Mart for Intensive Care database

“…Sepsis-3 is defined as a increase of ≥2 points in the sequential organ failure assessment (SOFA) score plus documented or suspected infection (1,28). Septic shock was defined by the International Classification of Diseases (ICD) code 78552 (ninth revision) and ICD code R6521 (10th revision) (29,30). Exclusion criteria included patients aged <18 years, patients whose BUN and albumin levels were not available during the first day of ICU admission, and patients without the length of hospital time.…”

Relationship between the Blood Urea Nitrogen to Creatinine Ratio and In-Hospital Mortality in Non-Traumatic Subarachnoid Hemorrhage Patients: Based on Propensity Score Matching Method

“…In addition, Zhu et al conducted a study of 509 hospitalized patients with acute heart failure and determined that UCR was an independent predictor of all-cause mortality and that elevated UCR was related to poor prognosis [ 22 ]. Moreover, Han et al used the MIMIC-III to determine the relationship between UCR and all-cause mortality in septic shock patients and found that a higher UCR was associated with increased mortality in these patients [ 8 ]. All the above results indicate that a higher UCR is associated with more serious conditions than a lower UCR.…”

“…Recently, it was reported that the BUN level is an effective prognostic factor for many cases, including ischemic stroke [ 2 ], chronic obstructive pulmonary disease [ 3 ], cardiogenic shock [ 4 ], acute ST-elevation myocardial infarction [ 5 ], neonatal sepsis [ 6 ], and bone marrow transplants [ 7 ]. The level of creatinine is commonly used to reflect the renal function, which can help to judge whether the renal function is in a stage of potential failure or improvement [ 8 ]. However, the level of BUN and creatinine can be affected by many factors, such as the use of corticosteroids, protein intake, and dehydration.…”

“…Therefore, the BUN/creatinine ratio (UCR) is a relatively useful parameter, which can reduce the effect of the above factors. In recent studies, it was reported that an elevated UCR is a poor prognosis factor for patients with septic shock [ 8 ], ischemic stroke [ 2 , 9 , 10 ], acute heart failure [ 11 ], and chronic heart failure [ 12 ].…”

Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database

“…The data cover 53 423 distinct hospital admissions for adult patients admitted to critical care units between 2001 and 2012, and many studies have been conducted to explore the clinical features of ICU patients using the database. [14][15][16]…”