Blood Urea Nitrogen and In-Hospital Mortality in Critically Ill Patients with Cardiogenic Shock: Analysis of the MIMIC-III Database.

En-Qian Liu,Chun-Lai Zeng,Yeong Shiong Chiew

doi:10.1155/2021/5948636

En-Qian Liu, Chun-Lai Zeng + Show 1 more

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https://doi.org/10.1155/2021/5948636

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Abstract

The association between blood urea nitrogen (BUN) and prognosis has been the focus of recent research. Therefore, the objective of this study was to investigate the association between BUN and hospital mortality in critically ill patients with cardiogenic shock (CS). This was a retrospective cohort study, in which data were obtained from the Medical Information Mart for Intensive Care III V1.4 database. Data from 697 patients with CS were analyzed. Logistic regression and subgroup analyses were used to assess the association between BUN and hospital mortality in patients with CS. The average age of the 697 participants was 71.14 years, and approximately 42.18% were men. In the multivariate logistic regression model, after adjusting for age, sex, diabetes, cardiac arrhythmias, urine output, simplified acute physiology score II, sequential organ failure assessment, creatinine, anion gap, and heart rate, high BUN demonstrated strong associations with increased in-hospital mortality (per standard deviation increase: odds ratio [OR] 1.47, 95% confidence interval [CI] 1.13–1.92). A similar result was observed in BUN tertile groups (BUN 23–37 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.42 [0.86–2.34]; BUN 38–165 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.99 [1.10–3.62]; P trend 0.0272). Subgroup analysis did not reveal any significant interactions among various subgroups, and higher BUN was associated with adverse clinical outcomes in patients with CS.

Highlights

Cardiogenic shock (CS) mainly manifests as hypoperfusion of end organs and hypoxia caused by decreased cardiac output [1, 2]
Patients with congestive heart failure, cardiac arrhythmias, diabetes, renal failure, and Acute kidney injury (AKI) were more likely to be in the high blood urea nitrogen (BUN) group
BUN per standard deviation (SD) increase was associated with hospital mortality

Summary

Introduction

Cardiogenic shock (CS) mainly manifests as hypoperfusion of end organs and hypoxia caused by decreased cardiac output [1, 2]. Acute myocardial infarction (AMI) complicated by left ventricular dysfunction is the most common cause of CS, which is the leading cause of hospital mortality in patients with AMI [3]. In the prospective SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) Trial Registry, in-hospital mortality in patients with cardiogenic shock (CS) complicating AMI was 60%, and patients with ventricular septal rupture had significantly higher mortality (87.3%) [4]. Patients with CS were at a higher risk of death during the first 4 weeks after admission in the Etude Française de l’Insuffisance Cardiaque Aigue (EFICA) study [5]. Continuous advances in reperfusion therapy and hospital mortality are still high A simple and convenient method is necessary to stratify patients with CS at high risk of death

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