Abstract 11060: Clinical Impact of the Barthel Index/Blood Urea Nitrogen Ratio to Predict the Post-Discharge Prognosis in Patients with Acute Decompensated Heart Failure

Abstract

Purpose: Several clinical models and scales have been reported to predict prognosis of patients who have hospitalized due to acute decompensated heart failure (ADHF). It is known that high blood urea nitrogen (BUN) levels and low activities of daily living are associated with a worse prognosis in patients with HF. Barthel Index (BI) is an ordinal scale used to measure performance in activities of daily living and functional independence in the domains of personal care and mobility. The aim of this study was to investigate the association between BI/BUN ratio and the incidence of clinical outcomes in patients with ADHF. Methods: A cohort of 76 patients admitted to our institution from August 2019 to December 2019 due to ADHF was enrolled. We investigated the characteristics of these patients and BI at their discharge. Clinical outcome was major adverse cardiovascular event (MACE) which include cardiovascular death and re-hospitalization for worsening HF. We performed ROC analysis for MACE. Results: The patients had a mean age of 78.0 years and 61.8% were male. Incidence of MACE was 51.3% in entire patients. We explored the association between BI/BUN ratio and post-discharge MACE. Area under the curve of BI/BUN ratio for MACE was 0.66(95% CI: 0.54-0.78) and the cut off value was 2.01 (specificity 0.784, sensitivity 0.538). We divided patients into 2 groups according to cut off value; high BI/BUN (>2: n=48) and low BI/BUN (<2: n=28). During the follow up periods (193±118 days), incidence of MACE was significantly higher in low BI/BUN group than in high BI/BUN group (71.4% vs. 39.6%, p=0.007). Kaplan-Meier curve of MACE showed high BI/BUN was better outcome compared with low BI/BUN (p=0.002, between log-rank test). After adjustment of multiple cofounders, BI/BUN ratio was a negative independent predictor for MACE (OR: 0.26 per increase, 95% confidence interval: 0.13-0.54, p=0.0003). Conclusion: We suggest that low BI/BUN ratio predicts poor prognosis in patients admitted due to ADHF.