Yuya Matsue1, Peter van der Meer1, Kevin Damman1, Marco Metra2, Christopher M O'Connor3, Piotr Ponikowski4, John R Teerlink5, Gad Cotter6, Beth Davison6, John G Cleland7, Michael M Givertz8, Daniel M Bloomfield9, Howard C Dittrich10, Ron T Gansevoort11, Stephan J L Bakker11,12, Pim van der Harst1, Hans L Hillege1,13, Dirk J van Veldhuisen1, Adriaan A Voors1. 1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 2. Department of Experimental and Clinical Medicine, University of Brescia, Brescia, Italy. 3. Inova Heart and Vascular Institute, Falls Church, Virginia, USA. 4. Medical University, Clinical Military Hospital, Wroclaw, Poland. 5. San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA. 6. Momentum Research, Durham, North Carolina, USA. 7. National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK. 8. Brigham and Women's Hospital, Boston, Massachusetts, USA. 9. Merck Research Laboratories, Rahway, New Jersey, USA. 10. University of Iowa Carver College of Medicine Cardiovascular Research Center, Iowa City, Iowa, USA. 11. Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 12. Top Institute Food and Nutrition, Wageningen, The Netherlands. 13. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
OBJECTIVE: The blood urea nitrogen-to-creatinine (BUN/creatinine) ratio has been proposed as a useful parameter in acute heart failure (AHF), but data on the normal range and the added value of the ratio compared with its separate components in patients with AHF are lacking. The aim of this study is to define the normal range of BUN/creatinine ratio and to investigate its clinical significance in patients with AHF. METHODS: In 4484 subjects from the general population without cardiovascular comorbidities, we calculated age-specific and sex-specific normal values of the BUN/creatinine ratio, deriving a higher and lower than normal range of BUN/creatinine ratio (exceeding the 95% prediction intervals). Association of abnormal range to prognosis was tested in 2033 patients with AHF for the outcome of all-cause death through 180 days, death or cardiovascular or renal rehospitalisation through 60 days and heart failure (HF) rehospitalisation within 60 days. RESULTS: In a cohort of patients with AHF, 482 (24.6%) and 28 (1.4%) patients with HF were classified into higher and lower than normal range groups, respectively. In Cox regression analysis, higher than normal range of BUN/creatinine ratio group was an independent predictor for all-cause death (HR: 1.86, 95% CI 1.29 to 2.66) and death or cardiovascular or renal rehospitalisation (HR: 1.37, 95% CI 1.03 to 1.82), but not for HF rehospitalisation (HR: 1.23, 95% CI 0.81 to 1.86) after adjustment for other prognostic factors including both creatinine and BUN. CONCLUSIONS: In patients with AHF, BUN/creatinine higher than age-specific and sex-specific normal range is associated with worse prognosis independently from both creatinine and BUN. CLINICAL TRIALS: gov identifier NCT00328692 and NCT00354458. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: The blood ureanitrogen-to-creatinine (BUN/creatinine) ratio has been proposed as a useful parameter in acute heart failure (AHF), but data on the normal range and the added value of the ratio compared with its separate components in patients with AHF are lacking. The aim of this study is to define the normal range of BUN/creatinine ratio and to investigate its clinical significance in patients with AHF. METHODS: In 4484 subjects from the general population without cardiovascular comorbidities, we calculated age-specific and sex-specific normal values of the BUN/creatinine ratio, deriving a higher and lower than normal range of BUN/creatinine ratio (exceeding the 95% prediction intervals). Association of abnormal range to prognosis was tested in 2033 patients with AHF for the outcome of all-cause death through 180 days, death or cardiovascular or renal rehospitalisation through 60 days and heart failure (HF) rehospitalisation within 60 days. RESULTS: In a cohort of patients with AHF, 482 (24.6%) and 28 (1.4%) patients with HF were classified into higher and lower than normal range groups, respectively. In Cox regression analysis, higher than normal range of BUN/creatinine ratio group was an independent predictor for all-cause death (HR: 1.86, 95% CI 1.29 to 2.66) and death or cardiovascular or renal rehospitalisation (HR: 1.37, 95% CI 1.03 to 1.82), but not for HF rehospitalisation (HR: 1.23, 95% CI 0.81 to 1.86) after adjustment for other prognostic factors including both creatinine and BUN. CONCLUSIONS: In patients with AHF, BUN/creatinine higher than age-specific and sex-specific normal range is associated with worse prognosis independently from both creatinine and BUN. CLINICAL TRIALS: gov identifier NCT00328692 and NCT00354458. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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