Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of "normal" creatinine.
Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of "normal" creatinine.
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DOI：
10.1097/ccm.0b013e3181ffe22a
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发表时间：
2011-02
影响因子：
8.8
通讯作者：
Christopher KB
中科院分区：
文献类型：
--
作者：
Beier K;Eppanapally S;Bazick HS;Chang D;Mahadevappa K;Gibbons FK;Christopher KB
我们假设，在异质性危重病人群中，BUN升高可能与全因死亡率相关，而与肌酐无关。在内科和外科重症监护室接受治疗的患者的多中心观察性研究。马萨诸塞州波士顿两家教学医院的20个重症监护室，26，288例患者，年龄≥ 18岁，1997年至2007年期间住院，肌酐0.80-1.30 mg/dl。ICU入院时的血尿素氮分为10-20、20-40和>40 mg/dl。Logistic回归分析了ICU入院后30、90和365天的死亡率以及住院死亡率。调整后的优势比估计多变量逻辑回归模型。ICU入院时BUN不能预测短期和长期死亡率，与肌酐无关。ICU入院后30天，BUN >40 mg/dl的患者相对于BUN 10-20 mg/dl的患者的死亡率比值比为5.12（95% CI，4.30-6.09; P<.0001）。在对混杂因素进行多变量调整后，BUN仍然是ICU入院后30天死亡率的重要预测因素，BUN >40 mg/dl的患者相对于BUN 10-20 mg/dl的患者的死亡率比值比为2.78（95% CI，2.27-3.39; P<.0001）。ICU入院后30天，BUN 20-40 mg/dl患者相对于BUN 10-20 mg/dl患者的OR为2.15（95% CI，1.98-2.33; <.0001），多变量OR为1.53（95% CI，1.40-1.68; P<.0001）。在ICU入院后90天和365天的结果以及住院死亡率相似。对血培养患者（n= 7，482）的亚组分析表明，ICU入院时的BUN与血培养阳性风险相关。在Cr 0.8-1.3 mg/dl的危重患者中，BUN升高与死亡率增加相关，与血清肌酐无关。
We hypothesized that elevated BUN can be associated with all cause mortality independent of creatinine in a heterogeneous critically ill population. Multicenter observational study of patients treated in medical and surgical intensive care units. 20 intensive care units in two teaching hospitals in Boston, Massachusetts 26,288 patients, age ≥ 18 years, hospitalized between 1997 and 2007 with creatinine 0.80–1.30 mg/dl. BUN at ICU admission was categorized as 10–20, 20–40 and >40 mg/dl. Logistic regression examined death at days 30, 90 and 365 post-ICU admission as well as in hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models. None BUN at ICU admission is predictive for short term and long term mortality independent of creatinine. 30 days following ICU admission, patients with BUN >40 mg/dl have an Odds Ratio for mortality of 5.12 (95% CI, 4.30–6.09; P<.0001) relative to patients with BUN 10–20 mg/dl. BUN remains a significant predictor of mortality at 30 days following ICU admission following multivariable adjustment for confounders, patients with BUN >40 mg/dl have an Odds Ratio for mortality of 2.78 (95% CI, 2.27–3.39; P<.0001) relative to patients with BUN 10–20 mg/dl. 30 days following ICU admission, patients with BUN 20–40 mg/dl have an OR of 2.15 (95% CI, 1.98–2.33; <.0001) and a multivariable OR of 1.53 (95% CI, 1.40–1.68; P<.0001) relative to patients with BUN 10–20 mg/dl. Results were similar at 90 and 365 days following ICU admission as well as in-hospital mortality. A subanalysis of patients with blood cultures (n= 7,482), demonstrated that BUN at ICU admission was associated with the risk of blood culture positivity. Among critically ill patients with Cr 0.8–1.3 mg/dl, an elevated BUN is associated with increased mortality, independent of serum creatinine.