open access

Vol 25, No 3 (2018)
Original articles — Clinical cardiology
Published online: 2017-06-20
Get Citation

Blood urea nitrogen in the prediction of in-hospital mortality of patients with acute aortic dissection

Jun Liu, Lian-Lian Sun, Jue Wang, Guang Ji
DOI: 10.5603/CJ.a2017.0075
·
Pubmed: 28653311
·
Cardiol J 2018;25(3):371-376.

open access

Vol 25, No 3 (2018)
Original articles — Clinical cardiology
Published online: 2017-06-20

Abstract

Background: Blood urea nitrogen (BUN) has been shown to be associated with adverse cardiovascular disease outcomes. The aim of the present study was to evaluate the prognostic role of BUN in patients with acute aortic dissection (AAD). Hypothesis: BUN has correlation with in-hospital mortality of patients with AAD.

Methods: Patients admitted to the emergency room within the first 24 h of onset of AAD were included in the study. BUN levels were measured on admission and the endpoints were mortality during hospi­talization after receiving surgical or endovascular repair.

Results: A total of 192 patients with AAD were enrolled. During hospitalization, 19 patients died and 173 patients survived. Increased levels of BUN (8.9 [7.0–9.7] vs. 6.0 [5.1–7.2] mmol/L, p < 0.001) were found in non-survivors compared with those survived. Using multivariable logistic analysis, BUN was an independent predictor of in-hospital mortality in patients with AAD (OR 1.415, 95% CI 1.016–1.971, p = 0.040). Furthermore, using receiver operating characteristic analysis, the optimal cutoff value for BUN was 6.95 mmol/L. Under this value, the area under the curve was 0.785 (95% CI 0.662–0.909, p < 0.001) and the sensitivity and specificity to predict in-hospital mortality was 78.9%, and 72.2%, respectively.

Conclusions: Admission BUN levels were an independent predictor for in hospital mortality in pa­tients with AAD.

Abstract

Background: Blood urea nitrogen (BUN) has been shown to be associated with adverse cardiovascular disease outcomes. The aim of the present study was to evaluate the prognostic role of BUN in patients with acute aortic dissection (AAD). Hypothesis: BUN has correlation with in-hospital mortality of patients with AAD.

Methods: Patients admitted to the emergency room within the first 24 h of onset of AAD were included in the study. BUN levels were measured on admission and the endpoints were mortality during hospi­talization after receiving surgical or endovascular repair.

Results: A total of 192 patients with AAD were enrolled. During hospitalization, 19 patients died and 173 patients survived. Increased levels of BUN (8.9 [7.0–9.7] vs. 6.0 [5.1–7.2] mmol/L, p < 0.001) were found in non-survivors compared with those survived. Using multivariable logistic analysis, BUN was an independent predictor of in-hospital mortality in patients with AAD (OR 1.415, 95% CI 1.016–1.971, p = 0.040). Furthermore, using receiver operating characteristic analysis, the optimal cutoff value for BUN was 6.95 mmol/L. Under this value, the area under the curve was 0.785 (95% CI 0.662–0.909, p < 0.001) and the sensitivity and specificity to predict in-hospital mortality was 78.9%, and 72.2%, respectively.

Conclusions: Admission BUN levels were an independent predictor for in hospital mortality in pa­tients with AAD.

Get Citation

Keywords

blood urea nitrogen, acute aortic dissection, in-hospital mortality

About this article
Title

Blood urea nitrogen in the prediction of in-hospital mortality of patients with acute aortic dissection

Journal

Cardiology Journal

Issue

Vol 25, No 3 (2018)

Pages

371-376

Published online

2017-06-20

DOI

10.5603/CJ.a2017.0075

Pubmed

28653311

Bibliographic record

Cardiol J 2018;25(3):371-376.

Keywords

blood urea nitrogen
acute aortic dissection
in-hospital mortality

Authors

Jun Liu
Lian-Lian Sun
Jue Wang
Guang Ji

References (17)
  1. Kirtane AJ, Leder DM, Waikar SS, et al. TIMI Study Group. 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. 2005; 45(11): 1781–1786.
  2. Brisco MA, Coca SG, Chen J, et al. Blood urea nitrogen/creatinine ratio identifies a high-risk but potentially reversible form of renal dysfunction in patients with decompensated heart failure. Circ Heart Fail. 2013; 6(2): 233–239.
  3. Smith GL, Shlipak MG, Havranek EP, et al. Serum urea nitrogen, creatinine, and estimators of renal function: mortality in older patients with cardiovascular disease. Arch Intern Med. 2006; 166(10): 1134–1142.
  4. Klein L, Massie BM, Leimberger JD, et al. OPTIME-CHF Investigators. Admission or changes in renal function during hospitalization for worsening heart failure predict postdischarge survival: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF). Circ Heart Fail. 2008; 1(1): 25–33.
  5. Ugajin M, Yamaki K, Iwamura N, et al. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med. 2012; 5: 583–589.
  6. Koutroumpakis E, Wu BU, Bakker OJ, et al. 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. Am J Gastroenterol. 2015; 110(12): 1707–1716.
  7. Rhoney DH, Parker D, Millis SR, et al. Kidney dysfunction at the time of intracerebral hemorrhage is associated with increased in-hospital mortality: a retrospective observational cohort study. Neurol Res. 2012; 34(5): 518–521.
  8. Takahashi T, Hasegawa T, Hirata N, et al. Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type III acute aortic dissection. Am J Cardiol. 2014; 113(11): 1904–1910.
  9. Ko T, Higashitani M, Sato A, et al. Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection. Am J Cardiol. 2015; 116(3): 463–468.
  10. Zhipeng Hu, Zhiwei W, Lilei Yu, et al. Sympathetic hyperactivity and aortic sympathetic nerve sprouting in patients with thoracic aortic dissection. Ann Vasc Surg. 2014; 28(5): 1243–1248.
  11. Li Y, Hu J, Qian H, et al. Novel findings: Expression of angiotensin-converting enzyme and angiotensin-converting enzyme 2 in thoracic aortic dissection and aneurysm. J Renin Angiotensin Aldosterone Syst. 2015; 16(4): 1130–1134.
  12. Schrier RW. Blood urea nitrogen and serum creatinine: not married in heart failure. Circ Heart Fail. 2008; 1(1): 2–5.
  13. Sands JM, Blount MA, Klein JD. Regulation of Renal Urea Transport by Vasopressin. Trans Am Clin Climatol Assoc. 2011; 122(122): 82–92.
  14. 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(7): 466–473.
  15. Fonarow GC, Adams KF, Abraham WT, et al. ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005; 293(5): 572–580.
  16. Miura M, Sakata Y, Nochioka K, et al. Prognostic impact of blood urea nitrogen changes during hospitalization in patients with acute heart failure syndrome. Circ J. 2013; 77(5): 1221–1228.
  17. Aronson D, Hammerman H, Beyar R, et al. Serum blood urea nitrogen and long-term mortality in acute ST-elevation myocardial infarction. Int J Cardiol. 2008; 127(3): 380–385.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl