Ratio Of Blood Urea Nitrogen Research Articles

Blood urea nitrogen to albumin ratio is a novel predictor of fatal outcome for patients with severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is associated with a high death rate and lacks a targeted therapy plan. The ratio of blood urea nitrogen to albumin, known as BAR, is a valuable method for assessing the outlook of various infectious diseases. The objective of this research was to evaluate the effectiveness of BAR in forecasting the outcome of individuals with SFTS. Four hundred and thirty-seven patients with SFTS from two clinical centers were included in this study according to inclusion and exclusion criteria. Clinical characteristics and test parameters of SFTS patients were analyzed between survival and fatal groups. Least absolute shrinkage and selection operator (LASSO) regression and Cox regression suggested that BAR might serve as a standalone prognostic indicator for patients with SFTS in the initial phase (hazard ratio = 18.669, 95% confidence interval [CI]: 8.558-40.725, p < 0.001). And BAR had a better predictive effectiveness in clinical outcomes in patients with SFTS with an AUC of 0.832 (95% CI: 0.788-0.876, p < 0.001), a cutoff value of 0.19, a sensitivity of 0.812, and a specificity of 0.726 compared to C-reactive protein, procalcitonin, and platelet to lymphocyte ratio via receiver operating characteristic curve. KM (Kaplan Meier) curves demonstrated that high level of BAR was associated with poor survival condition in patients with SFTS. Furthermore, the high level of BAR was associated with long hospital stays and test paraments of kidney, liver, and coagulation function in survival patients. So, BAR could be used as a promising early warning biomarker of adverse outcomes in patients with SFTS.

Need for a consensus definition of chronic dehydration: A scoping review.

Dehydration is common in older adults and impacts their clinical outcomes. Chronic dehydration is especially important as it has been under-recognized. This scoping review aimed to summarize the available definitions of chronic dehydration to identify gaps between each definition and discuss future research needs. Four databases (Pubmed, CINAHL, Cochrane Library, Science Direct) were systematically searched for peer-reviewed articles that clearly described the definition of chronic dehydration published from inception to June 8th, 2023. Two researchers reviewed the articles independently, and any disagreement was solved upon discussion. We identified five articles with a wide range of subjects from children to older adults. Chronic dehydration was defined as a state of persistently elevated blood urea levels; weight loss ≥ 1% as a result of fluid loss; a ratio of blood urea nitrogen to creatinine > 20; serum osmolarity ≥ 295 mOsm/kg; and a dehydrated state lasting 72 hours or longer. The definition varied among studies, indicating the need to establish an international consensus on the definition of chronic dehydration.

Coal mining environment causes adverse effects on workers.

The objective of this study is to study the adverse effects of coal mining environment on workers to discover early effective biomarkers. The molecular epidemiological study was conducted with 502 in-service workers, who were divided into miner and auxiliary. We measured the individual levels of dust exposure for participants. Clinical examinations were conducted by qualified doctors. Peripheral blood was collected to measure biochemistry, hemogram, and karyocyte apoptosis. All workers were healthy who have not found with any diseases that can be diagnosed medically in the physical examination and showed no difference in dust exposure level, age, height, weight, and body mass index between groups. The working years of miners were lower than that of auxiliaries (p < 0.001). Compared with auxiliaries, the concentration and percentage of lymphocytes (p = 0.040, p = 0.012), basophils (p = 0.027, p = 0.034), and red blood cells (p < 0.001) and the concentration of hemoglobin of miners were lower (p < 0.001). The percentage of neutrophils (p = 0.003), the concentration of mean corpuscular hemoglobin concentration (p = 0.002), and the proportion of karyocyte apoptosis in miners were higher (p < 0.001). Miners presented higher blood urea nitrogen (p < 0.001), ratio of blood urea nitrogen to creatinine (p < 0.001), the high density lipoprotein cholesterol (p < 0.001), lower creatinine (p < 0.05), and cholesterol (p < 0.001). The coal mining environment impacted mining workers' immune function, renal function, and the hematopoietic system, including BUN/CRE, HGB, RBC, and LYMPH, which could be used as early biomarkers to screen the health of coal miners.

Effect of a Dietary Intervention on Insulin Requirements and Glycemic Control in Type 1 Diabetes: A 12-Week Randomized Clinical Trial.

This study compared the effects of a low-fat vegan diet to those of a portion-controlled diet in people with type 1 diabetes. Over 12 weeks, the average total daily dose of insulin decreased significantly and insulin sensitivity increased significantly in the vegan group, while no significant changes were observed in the group receiving the portion-controlled diet. Total and LDL cholesterol decreased in the vegan group, as did the ratio of blood urea nitrogen to creatinine. A1C decreased in both groups. These findings suggest that a low-fat vegan diet may yield improvements in insulin sensitivity, insulin requirements, glycemic control, and markers of cardiovascular and renal health compared with a portion-controlled diet in people with type 1 diabetes.

The role of dehydration in the development of acute kidney injury in patients with COVID-19

Background. Acute kidney injury often complicates the course of COVID-19; in many patients it develops even before hospitalization, and the reasons for its development are not sufficiently clear.&#x0D; Aim. To study the role of dehydration in the development of community-onset acute kidney injury in COVID-19.&#x0D; Material and methods. 329 patients with COVID-19 were examined (age 58.014.3 years, 172 men, 157 women). Acute kidney injury was diagnosed according to the Russian recommendations of 2020. To determine prerenal acute kidney injury, the ratio of blood urea nitrogen to blood creatinine was calculated, and to diagnose dehydration the calculated osmolarity of blood serum. Data are presented for a normal distribution as the arithmetic mean and standard deviation (MSD), for a non-normal distribution as a median (Me) and interquartile range (IQR). Univariate and multivariate logistic regression analyzes were used. To assess the diagnostic significance of quantitative characteristics in predicting a certain outcome, the ROC curve analysis method was used. Differences were considered statistically significant at p 0.05.&#x0D; Results. Acute kidney injury was diagnosed in 70 (21.3%) patients, of which 58 (82.9%) were community-acquired. In 16 (27.6%) patients with community-onset acute kidney injury, it was of a prerenal nature, of which in 13 (81.3%) the calculated serum osmolarity exceeded 295 mOsm/L. Independent factors directly associated with prerenal prehospital acute kidney injury were estimated serum osmolarity (p 0.001), C-reactive protein level (p 0.001) and age (p=0.003) (R2=0.23, F=33,34).&#x0D; Conclusion. Acute kidney injury complicates the course of COVID-19, and in most patients, it develops even at the prehospital stage. Estimated serum osmolarity is directly and independently associated with prerenal community-onset acute kidney injury, suggesting the important role of dehydration in its development.

PFAS levels in paired drinking water and serum samples collected from an exposed community in Central North Carolina

The community of Pittsboro, North Carolina has been documented to have extensive per- and polyfluoroalkyl substances (PFAS) contamination in its drinking water source, the Haw River, over the last 20 years. However, a detailed exposure assessment has never been conducted. In this study, we sought to characterize the PFAS in paired drinking water and blood samples collected from a small cohort of Pittsboro residents (n = 49). Drinking water and serum from blood were collected from adults in late 2019 and early 2020 and were analyzed to quantify 13 PFAS analytes. In order to explore potential health effects of PFAS exposure, serum was further analyzed for clinical chemistry endpoints that could be potentially associated with PFAS (e.g., cholesterol, liver function biomarkers). PFAS were detected in all serum samples, and some serum PFAS concentrations were 2 to 4 times higher than the median U.S. serum concentrations reported in the general U.S. population. Of the 13 PFAS in drinking water, perfluorohexanoic acid (PFHxA) was measured at the highest concentrations. PFAS levels in the current drinking water were not associated with current serum PFAS, suggesting that the serum PFAS in this cohort likely reflects historical exposure to PFAS with long half-lives (e.g., PFOS and PFOA). However, one PFAS with a shorter half-life (PFHxA) was observed to increase in serum, reflecting the temporal variability of PFHxA in river and drinking water. Statistical analyses indicated that serum PFOA and PFHxS were positively associated with total cholesterol and non-HDL cholesterol. No serum PFAS was associated with HDL cholesterol. In the clinical chemistry analyses, serum PFHxA was found to be negatively associated with electrolytes and liver enzymes (e.g., AST and ALT), and serum PFOS was found to be positively associated with the ratio of blood urea nitrogen to creatinine (BUN:Cre). While small in size, this study revealed extensive exposure to PFAS in Pittsboro and associations with clinical blood markers, suggesting potential health impacts in community residents.

Prognostic impact of blood urea nitrogen to albumin ratio on patients with sepsis: a retrospective cohort study

To investigate the ability of the ratio of blood urea nitrogen (BUN) to serum albumin ratio (BAR) in patients with sepsis in intensive care units (ICUs) to predict the prognosis of short-and long-term death. Data are from the Marketplace for Intensive Care Medical Information IV (MIMIC-IV v2.0) database for patients with sepsis as defined by SEPSIS-3. The primary outcome was 30-day mortality and the secondary outcome was 360-day mortality. Kaplan–Meier (KM) survival curves were plotted to describe differences in BAR mortality in different subgroups and area under the curve (AUC) analysis was performed to compare the predictive value of sequential organ failure assessment (SOFA), BAR, blood urea nitrogen (BUN) and albumin. Multivariate Cox regression models and subgroup analysis were used to determine the correlation between BAR and 30-day mortality and 360-day mortality. A total of 7656 eligible patients were enrolled in the study with a median BAR of 8.0 mg/g, including 3837 in the ≤ 8.0 group and 3819 in the BAR > 8.0 group, with 30-day mortality rates of 19.1% and 38.2% (P < 0.001) and 360-day mortality rates of 31.1% and 55.6% (P < 0.001). Multivariate Cox regression models showed an increased risk of death for 30-day mortality (HR = 1.219, 95% CI 1.095–1.357; P < 0.001) and 360-day mortality (HR = 1.263, 95% CI 1.159–1.376; P < 0.001) in the high BAR group compared to the low BAR group. For the 30-day outcome, the area under the curve (AUC) was 0.661 for BAR and 0.668 for 360-day BAR. In the subgroup analysis, BAR remained an isolated risk factor for patient death. As a clinically inexpensive and readily available parameter, BAR can be a valuable forecaster of prognosis in patients with sepsis in the intensive care unit.

600-P: Higher Hydration Status Is Indicative of Better Glucose Tolerance

Introduction: Water intake is an important dietary behavior to replace high-caloric beverages and to enhance metabolic health. Type 2 diabetes is a metabolic disorder that has been shown to be more prevalent in Hispanics, a population shown to consume relatively less water compared to non-Hispanic Whites. The underlying cause of type 2 diabetes is insulin resistance, characterized by hyperglycemia and impaired glycemic control. However, whether a relationship exists between dehydration and the development of diabetes remains to be elucidated. Purpose: To evaluate if hydration status indicates glucose tolerance among a dominant Mexican American population. Methods: Sixty-one participants without diabetes (Age: 26.5 ± 9.1 years; BMI: 27.5 ± 6.0 kg/m2) participated in the study. Fasting blood glucose level was determined, and a 2-hour glucose tolerance test was performed following the ingestion of a 75g glucose drink. Blood glucose concentration levels were determined at 15−, 30−, 60−, 90−, and 120-minute time intervals post ingestion and glucose area under the curve was analyzed as well. Blood works were performed to determine blood urea nitrogen (BUN) and creatinine concentrations. Hydration status was estimated using the ratio of BUN to creatinine values. Results: Hydration status measured by BUN/Creatinine was positively associated with glucose intolerance measured at 15−, 30−, 60−, and 90-minute post glucose load and by glucose area under the curve (r=0.33; r=0.43; r=0.37; r=0.27; and r=0.41 respectively; p&amp;lt;0.05). Conclusion: Adequate fluid consumption should be encouraged for glycemic control, especially among people with high diabetes risks. Disclosure J.Apaflo: None. J.Labadah: None. G.Narvaez: None. V.M.Rocha: None. A.Mossayebi: None. S.Bajpeyi: None.

Blood urea nitrogen to creatinine ratio is associated with physical frailty in older-aged Chinese: a cross-sectional study.

The relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and physical frailty in elderly patients remains unclear. The study aims to investigate the association between the BUN/Cr ratio and physical frailty in the elderly Chinese population. In this cross-sectional analysis, the clinical data of 5213 participants from 2015 were selected from the China Health and Retirement Longitudinal Study (CHARLS). The demographic variables (including age and gender) and health behavior (including smoking and drinking history), anthropometric (including systolic and diastolic blood pressure, waist circumference (WC), etc.), physical performances (i.e., grip strength, repeated chair stands, etc.), and biochemical indicators (i.e., blood urea nitrogen (BUN), creatinine(Cr), total cholesterol (TC), triglycerides (TG), etc.) were measured. The association between the BUN/Cr ratio and physical frailty was analyzed. After adjusting for potential confounding factors, smooth curve fitting showed a linear relationship between the BUN/Cr ratio and grip strength, a non-linear relationship between the BUN/Cr ratio, and repeated chair-rising time. The fully adjusted linear regression results showed a negative association between the BUN/Cr ratio and grip strength. In the multivariate, piecewise linear regression, when the BUN/Cr ratio was greater than 18.60, the repeated chair-rising time increased with the increase in BUN/Cr ratio (β = 0.046, 95%CI 0.025, 0.066; p < 0.001). However, we did not observe a significant correlation when the BUN/Cr ratio was less than 18.60 (β = -0.007, 95%CI -0.046, 0.032; p = 0.717). This study demonstrated that the BUN/Cr ratio might be associated with physical frailty in older-aged Chinese, and this association requires further investigation.

High blood urea nitrogen to creatinine ratio is associated with increased risk of sarcopenia in patients with chronic obstructive pulmonary disease

Background and aimsSarcopenia has been reported to be a prognostic factor for chronic obstructive pulmonary disease (COPD). However, the relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and sarcopenia in patients with COPD remain unclear. Therefore, the purpose of this study is to explore whether the ratio can be used as a predictor of sarcopenia in hospitalized COPD patients. MethodsThe skeletal muscle area index (SMI) at the level of the 12th thoracic vertebra (T12) was used to assess the risk of sarcopenia in patients. This single center cross-sectional study was conducted by analyzing the clinical parameters and identifying the T12 skeletal muscle area (SMA) and density (SMD) on chest CT images of COPD hospitalized patients admitted to the respiratory department of our hospital from March 2018 to August 2021. The study enrolled 265 hospitalized patients. Based on the different statistical properties of the above variables, differences between groups were measured by independent sample Student t-tests, Mann-Whitney U tests, or Chi-Square tests. Multivariable linear regression analysis was used to evaluate the relationship between the value of BUN/Cr and the risk of sarcopenia. ResultsThe serum BUN/Cr ratio was negatively correlated with SMI (r = −0.201, p = 0.001) in COPD patients, and multivariate linear regression analysis showed that this ratio was associated with the risk of sarcopenia (β = −0.109, p = 0.041). The optimal cut-off value of BUN/Cr ratio for identifying COPD patients with sarcopenia was 97.893. There was also a significant negative correlation between serum BUN/Cr ratio and forced vital capacity (FVC; r = −0.235, p < 0.001) and forced expiratory volume in the first second (FEV1; r = −0.219, p < 0.001). ConclusionThe BUN/Cr ratio can be used to predict sarcopenia and evaluate pulmonary function in hospitalized COPD patients.

Diagnostic Values of Blood Urea Nitrogen (BUN), Creatinine (Cr), and the Ratio of BUN to Cr for Distinguishing Heart Failure from Asthma and Chronic Obstructive Pulmonary Disease

Background In clinical practise, it can be challenging to tell the difference between asthma and chronic obstructive pulmonary disease (COPD) and heart failure (HF), which share comparable dyspnea symptoms. We aimed to examine whether renal function indexes blood urea nitrogen (BUN), creatinine (Cr), and the ratio of BUN to Cr (BUN/Cr) can be used to distinguish HF from asthma and COPD. Methods A total of 170 patients were admitted for dyspnea symptoms in this retrospective study. There are 69 patients with HF (HF group), 50 patients with asthma (asthma group), and 51 patients diagnosed with COPD (COPD group). The levels of BUN, Cr, and the ratio of BUN/Cr in the three groups were compared. Student's t-test or the one-way analysis of variance (ANOVA) test was used to compare means. Using the area under the receiver operating characteristic curve, model differentiation was evaluated (AUC). Z-test comparisons of AUC were carried out. Results Compared with the asthma/COPD group (asthma group + COPD group) or the COPD group, the levels of BUN and Cr were raised in the HF group, while there was no significant difference of the BUN/Cr ratio. Compared with those in the asthma group, the levels of BUN, Cr, and BUN/Cr ratio were significantly increased in the HF group (all p < 0.05), whereas no significant differences of BUN, Cr, and BUN/Cr ratio were found between asthma and COPD. The AUC in distinguishing HF from asthma/COPD were 0.736 and 0.751 for BUN and Cr, respectively, and no significant difference was observed between BUN and Cr. The cutoff values (specificity, sensitivity, and Youden index) in distinguishing between HF and asthma/COPD were 20.45 mg/dL (79.21%, 56.52%, and 0.357) for BUN and 0.782 mg/dL (72.28%, 68.12%, and 0.404) for Cr, respectively. Conclusions BUN and Cr showed accurate and reliable diagnostic values which could be potential biomarkers for differentiating HF from asthma and/or COPD.

P1082COMPARISON OF THE REMOVAL OF PROTEIN-BOUND TOXINS AND LARGE MIDDLE MOLECULES WITH HIGH-FLUX PMMA AND MEDIUM CUT-OFF DIALYZERS

Abstract Background and Aims Dialytic clearance of protein-bound toxins and large middle molecules is poor by diffusive treatment and limited by high-flux hemodialysis (HD) and on-line hemodiafiltration (OL-HDF), and only a few studies have examined how to improve their removal by other extracorporeal strategies. Since 2017, there is a new generation of polymethyl methacrylate (PMMA) membranes that suppress platelet adhesion on the membrane surface improving hemocompatibility and permeability, while also maintaining adsorption properties related to conventional PMMA membranes. Expanded HD (HDx) with medium cut-off (MCO) membranes has also recently been incorporated into clinical practice and may improve the removal of uremic toxins in HD treatments. The aim of this pilot study was to compare the efficacy of a new high-flux PMMA dialyzer (Filtryzer® NF-2.1H) in a post-dilution OL-HDF session with a new MCO membrane (Theranova® 400) in a HDx session. Method In an open, cross-over, single-center, controlled, prospective clinical study, 40 adult stable HD patients were assigned to be treated by post-dilution OL-HDF with the NF-2.1H dialyzer or by HDx with the Theranova 400 dialyzer. All other dialysis parameters, including blood and dialysate flow rates, length of dialysis session, and ultrafiltration rate remained unchanged during both sessions. P-cresyl sulfate (PCS), indoxyl sulfate (IS), and kappa (κ) and lambda( λ) free light chains (FLC) reduction rates were intraindividually compared for the two dialyzer types (primary outcomes). Secondary outcomes included the kt and the reduction ratio of blood urea nitrogen, phosphate and β2 -microglobulin (β 2-m). Results The reduction ratio of protein-bound toxins ranges from 60% to 67%, with no differences between membranes (Figure). PMMA membrane achieved greater FLC reduction ratios than MCO membrane, reaching significance for λFLC (56.6% vs. 77.4%; p &amp;lt; 0.001). Conversely, β2M reduction ratio was slightly but significantly higher with MCO membrane (68.5 vs. 72.1%; p = 0.002). Small molecules removal including urea and phosphate were similar in both groups, achieving an optimal Kt with no differences between groups (61.3±9.2 Vs. 59.7±9.3; p=0.16). Albumin reduction ratio tended to be higher with PMMA membrane without reaching significance (10.1±5.9% Vs. 7.8±12.3%; p=0.17). The mean convective volume achieved with PMMA was 23.5±4.4 L. Conclusion This study suggested that new high-flux PMMA dialyzer in post-dilution OL-HDF mode might achieve better FLC reduction ratios than MCO dyalizer in HDx mode, whereas both techniques may equally remove protein-bound toxins. OL-HDF with new PMMA membranes could be a good dialysis strategy for adding convective transport to the well-known mechanisms of diffusion and absorption previously described with conventional PMMA membranes, enabling an adequate substitution volume.

Genetic or pharmacologic blockade of enhancer of zeste homolog 2 inhibits the progression of peritoneal fibrosis.

Dysregulation of histone methyltransferase enhancer of zeste homolog 2 (EZH2) has been implicated in the pathogenesis of many cancers. However, the role of EZH2 in peritoneal fibrosis remains unknown. We investigated EZH2 expression in peritoneal dialysis (PD) patients and assessed its role in peritoneal fibrosis in cultured human peritoneal mesothelial cells (HPMCs) and murine models of peritoneal fibrosis induced by chlorhexidine gluconate (CG) or high glucose peritoneal dialysis fluid (PDF) by using 3-deazaneplanocin A (3-DZNeP), and EZH2 conditional knockout mice. An abundance of EZH2 was detected in the peritoneum of patients with PD associated peritonitis and the dialysis effluent of long-term PD patients, which was positively correlated with expression of TGF-β1, vascular endothelial growth factor, and IL-6. EZH2 was found highly expressed in the peritoneum of mice following injury by CG or PDF. In both mouse models, treatment with 3-DZNeP attenuated peritoneal fibrosis and inhibited activation of several profibrotic signaling pathways, including TGF-β1/Smad3, Notch1, epidermal growth factor receptor and Src. EZH2 inhibition also inhibited STAT3 and nuclear factor-κB phosphorylation, and reduced lymphocyte and macrophage infiltration and angiogenesis in the injured peritoneum. 3-DZNeP effectively improved high glucose PDF-associated peritoneal dysfunction by decreasing the dialysate-to-plasma ratio of blood urea nitrogen and increasing the ratio of dialysate glucose at 2h after PDF injection to initial dialysate glucose. Moreover, delayed administration of 3-DZNeP inhibited peritoneal fibrosis progression, reversed established peritoneal fibrosis and reduced expression of tissue inhibitor of metalloproteinase 2, and matrix metalloproteinase-2 and -9. Finally, EZH2-KO mice exhibited less peritoneal fibrosis than EZH2-WT mice. In HPMCs, treatment with EZH2 siRNA or 3-DZNeP suppressed TGF-β1-induced upregulation of α-SMA and Collagen I and preserved E-cadherin. These results indicate that EZH2 is a key epigenetic regulator that promotes peritoneal fibrosis. Targeting EZH2 may have the potential to prevent and treat peritoneal fibrosis. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

611 Finding the Ideal BUN to Creatinine Ratio in an Upper GI Bleed

INTRODUCTION: The ratio of blood urea nitrogen (BUN) to creatinine can be used as a surrogate for identifying sources of upper gastrointestinal bleed (UGIB). The proposed mechanism of this “accelerated azotemia” is brisk bleeding above the ligament of Treitz, followed by blood protein breakdown and absorption in the upper GI tract in the setting of hypovolemia and subsequent kidney hypoperfusion. Several ratios have been described in the literature, with variable sensitivities and specificities, but there is no consensus on the ideal ratio for recognizing an UGIB. Our study seeks to expand upon a prior research study done at our institution to determine the sensitivity, specificity, and positive predictive value (PPV) of gradated BUN/creatinine ratios (20:1 to 100:1) in identifying an UGIB. METHODS: 1,194 patients were identified between 2008 and 2016 using “Looking Glass Clinical Analytics”TM. Inclusion criteria were patients admitted with hematochezia, melena, or hematemesis, with a decrease in hemoglobin (Hb) of &gt;1 g/dL from baseline. Patients with chronic kidney disease stage 3 or greater were excluded. Demographic data and source of bleeding were collected. Hb, BUN, and creatinine values were collected at baseline, day 1, and day 2 of admission. Sensitivity, specificity, and PPV were calculated for each ratio. A receiver operating characteristic (ROC) curve was created for day 1 and 2 of admission. RESULTS: 604 patients had GI bleeding confirmed by endoscopy. Average age was 67 years, 50% (n = 302) were female, and 76% (n = 459) were Black or Hispanic. 62% (n = 375) had a confirmed UGIB source. Median change in Hb from baseline was 3.0 g/dL. For a BUN/creatinine ratio of ≥20:1 on day 1, specificity was 66.67%, sensitivity was 73.32%, and PPV was 78.16%. Values for day 1 and 2 of hospital admission are listed in Tables 1 and 2. ROC curve on day 1 (Figure 1) had an area of under the curve of 0.68 (CI = 0.64-0.73). CONCLUSION: A BUN/creatinine ratio of ≥30:1 has a PPV of 84% and may be ideal for identifying an UGIB. Interestingly, as the ratio increases above 30:1, the PPV plateaus and the likelihood of UGIB does not increase further. The specificity of UGIB at 30:1 is high at 85%. The ROC curve shows that the BUN/creatinine ratio is an accurate test for predicting an UGIB. This indicates that in clinical practice, a patient presenting with GI bleeding and a drop in hemoglobin ≥1 g/dL associated with an “accelerated azotemia” of ≥30:1 should first undergo upper endoscopy to localize a bleeding source.

Different diuretic properties between tolvaptan and furosemide in congestive heart failure patients with diuretic resistance and renal impairment: a subanalysis of the K-STAR.

We attempted to identify the difference in diuretic properties between tolvaptan (TLV) and furosemide (FUR) in congestive heart failure (CHF) patients with loop diuretic resistance and renal impairment. We investigated 81 CHF patients with loop diuretic treatment and renal impairment included in t he Kanagawa Aquaresis Investigators Trial of Tolvaptan on Heart Failure Patients with Renal Impairment (K-STAR). Predictive baseline factors and their changes during treatment periods were analyzed for correlation with percentage change in urine volume (%ΔUV) after additive introduction of TLV or increasing doses of FUR. Higher urine osmolality at baseline (β = 0.355; p = 0.033) in the TLV group and a lower ratio of blood urea nitrogen to serum creatinine (BUN/Cr, β = - 0.405; p = 0.020) in the FUR group were predictive of higher %ΔUV. Higher Δfree-water clearance (β = 0.667; p < 0.0001) in the TLV group, and higher %ΔBUN/Cr (β = 0.344; p = 0.030), higher %Δurine sodium concentration (β = 0.337; p = 0.037), and lower %Δstroke volume (β = - 0.390; p = 0.017) in the FUR group were correlated with %ΔUV. In conclusion, baseline urine osmolality and change in free-water clearance with additive introduction of TLV and a changing ratio of BUN/Cr with increasing doses of FUR were identified as key clinical parameters related to diuretic response.Trial registration UMIN000009201.

Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery.

To examine the prevalence of dehydration upon hospital admission and its association with postoperative complications in older persons undergoing orthopaedic surgery. Ageing-related physiological and pathological changes, as well as suboptimal care quality, can render older persons vulnerable to dehydration. However, few empirical studies have been conducted to examine the association between dehydration and care outcomes in this population. Retrospective documentary review. The medical records of patients who were aged 65years or above and admitted for orthopaedic surgery at an acute hospital in Hong Kong over the period of January 2013 to June 2013 were reviewed. The sociodemographic characteristics, health conditions, laboratory results during index hospitalisation, postoperative care and 1-month survival were analysed. Dehydration status was defined on the basis of the ratio of blood urea nitrogen to creatinine upon admission. Of 310 reviewed records, 216 records were included in the analysis. A total of 21.8% of the patients in the included cases were defined as dehydrated and 35.2% were defined as at risk of dehydration. There were significantly more patients in the dehydrated group were female, having diuretic medication, swallowing difficulty, oedema, tube feeding, diaper or urinary catheter use, with postoperative complications in respiratory, gastrointestinal and haematological systems, and died within 30days than those in the euhydrated group. The findings of this study reveal that dehydration is highly prevalent among older persons on admission. Female gender and swallowing difficulty were found to be significantly associated with dehydration, although causal inference could not be delineated through this retrospective study. Given its significant influence on care outcomes and postoperative recovery, hydration care that promotes early recognition and timely management of dehydration is an integral part of fundamental care for older persons.

PROGNOSTIC PARAMETERS FOR THE RECOVERY OF RENAL FUNCTION IN PATIENTS WITH OBSTRUCTIVE UROPATHY

Objective: The aim of this study was to determine the prognostic parameters for the recovery of renal function in patients with obstructive uropathy after the release of obstruction. Material &amp; methods: This is a retrospective cohort study. Secondary data from the patient's medical record was used to determine whether the ratio of blood urea nitrogen (BUN)/creatinine, hemoglobin, hyperkalemia, blood glucose, renal parenchymal thickness, and obstruction etiology are prognostic parameters for recovery of renal function in patients with obstructive uropathy after release of obstruction. Bivariate was used to analyze the data using Chi-square and Fisher's exact test with significance level of p&lt;0.05 to evaluate the significance. Results: Based on total of 66 research samples, it was found that renal parenchymal thickness was ≥10 mm (p=0.001), hemoglobin level was ≥10 mg/dL (p=0.001), and BUN/creatinine ratio was ≥10 (p=0.003), it had significant correlation with the recovery of renal function, meanwhile, obstruction etiology variable (p=0.566), and hyperkalemia (p=0.792) did not provide significant recovery of renal function. Conclusion: Renal parenchymal thickness, hemoglobin level, and BUN/Creatinin ratio are the prognostic parameters for recovery of renal function after release of obstruction.

Abstract 19103: Tolvaptan Increases Urine Output Without Hemodynamic Impairment in Heart Failure Patients With Renal Dysfunction

Introduction: There has been scant clinical evidence on whether the aquaretic effect of tolvaptan (TLV) contributes to decongestion without further renal impairment compared with furosemide (FUR). Methods: The Kanagawa Aquaresis Investigators Trial of TLV on Heart Failure Patients with Renal Impairment (K-STAR) is a multicenter, open-labeled, randomized, controlled prospective clinical study of 81 patients with heart failure (HF) in Japan. Patients with residual signs of congestion despite treatment with oral FUR at a dose of ≥40 mg/day with baseline estimated glomerular filtration rates of &lt;45 mL/min were randomly assigned to two groups for 7-day treatments with either ≤15 mg/day of additive TLV or ≤40 mg/day of FUR. Results: During the treatment period, a more significant increase from baseline in urine volume (%ΔUV) was seen in the TLV group than in the FUR group (+42 ± 43% in the TLV group vs. +15 ± 39% in the FUR group, p &lt; 0.01). Renal function was better preserved in the TLV group than in the FUR group [increase in serum creatinine (%ΔCr): +3 ± 13% in the TLV group vs. +10 ± 14% in the FUR group, p = 0.015]. Increases in the ratio of blood urea nitrogen to %ΔCr and %ΔUV were positively correlated in the FUR group (r = 0.33, p = 0.03) but were not significantly correlated in the TLV group (r = -0.15, p = 0.34). Moreover, an increase in pulse rate (%ΔPR: r = 0.31, p = 0.04) and decrease in stroke volume (%ΔSV: r = –0.35, p = 0.04) were positively correlated to the %ΔUV in the FUR group but not in the TLV group (%ΔPR: r = 0.10, p = 0.51; %ΔSV: r = –0.08, p = 0.65; respectively). Conclusions: TLV increases UV with less hemodynamic and renal impairment by maintaining adequate intravascular volume compared with FUR in HF patients with renal dysfunction.

Abstract W P332: Ratio of Blood Urea Nitrogen to Serum Creatinine Predicts Primary Intracerebral Hemorrhage Volume

Background&amp;Purpose: Dehydration is associated with poor outcomes in stroke patients. A common marker of hydration status is the calculated blood urea nitrogen (BUN) to serum creatinine (SCr) ratio. Few studies in primary ICH patients have focused on intravascular volume depletion and ICH volume. We examined if dehydration (BUN/SCr &gt; 15) predicted admission ICH volume. Subjects&amp;Methods: Consecutive patients (2008 – 2013) who presented with a spontaneous ICH to our academic stroke center in the Southeast US were retrospectively analyzed. Demographics, initial lab values, ICH volumes, and ICH scores were recorded. Patients with INR &lt;= 1.5 were divided into two groups: BUN/SCr &lt;= 15 and &gt; 15. ICH volumes were compared between groups. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP) and ICH score. Results: We identified 326 patients who met inclusion criteria (mean age 63; SD=15, 43% women, 45% black). Patients with ratio &gt;15 were older (68 vs.60 years, p&lt;0.001). In addition, a higher proportion were white (63% vs.40%, p &lt;0.001) and female (56% vs. 36%, p&lt;0.001). The average SBP on arrival was similar between groups (176 vs.181 mmHg, p=0.159). The average initial ICH volumes for those with BUN/SCr &gt; 15 were higher than patients with BUN/SCr &lt;= 15 (29.6 mL vs. 20.6 mL, p = 0.022). After adjusting for SBP and ICH score, patients with elevated BUN/SCr had an average of 9 mL larger ICH volumes on admission. Conclusions: Elevated BUN/SCr ratio is linked to larger initial ICH volumes even after controlling for ICH score and SBP. This simple ratio is an independent predictor of ICH volume, may reflect poor hydration status, and can potentially be used in the early evaluation and treatment of ICH patients. Future studies to determine if correction impacts functional outcomes are warranted.

A case of mouthwash as a source of ethanol poisoning: is there a need to limit alcohol content of mouthwash?

A case of mouthwash as a source of ethanol poisoning: is there a need to limit alcohol content of mouthwash?