TY - JOUR
T1 - Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of normal creatinine
AU - Beier, Kevin
AU - Eppanapally, Sabitha
AU - Bazick, Heidi S.
AU - Chang, Domingo
AU - Mahadevappa, Karthik
AU - Gibbons, Fiona K.
AU - Christopher, Kenneth B.
N1 - Funding Information:
Supported, in part, by the National Institutes of Health (5K08AI060881 to KC).
PY - 2011/2
Y1 - 2011/2
N2 - Objective: We hypothesized that elevated blood urea nitrogen can be associated with all-cause mortality independent of creatinine in a heterogeneous critically ill population. Design: Multicenter observational study of patients treated in medical and surgical intensive care units. Setting: Twenty intensive care units in two teaching hospitals in Boston, MA. Patients: A total of 26,288 patients, age 18 yrs, hospitalized between 1997 and 2007 with creatinine of 0.80-1.30 mg/dL. Interventions: None. Measurements: Blood urea nitrogen at intensive care unit admission was categorized as 10-20, 20-40, and >40 mg/dL. Logistic regression examined death at days 30, 90, and 365 after intensive care unit admission as well as in-hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models. Main Results: Blood urea nitrogen at intensive care unit admission was predictive for short- and long-term mortality independent of creatinine. Thirty days following intensive care unit admission, patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 5.12 (95% confidence interval, 4.30-6.09; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Blood urea nitrogen remained a significant predictor of mortality at 30 days after intensive care unit admission following multivariable adjustment for confounders; patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 2.78 (95% confidence interval, 2.27-3.39; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Thirty days following intensive care unit admission, patients with blood urea nitrogen of 20-40 mg/dL had an odds ratio of 2.15 (95% confidence interval, 1.98-2.33; <.0001) and a multivariable odds ratio of 1.53 (95% confidence interval, 1.40-1.68; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Results were similar at 90 and 365 days following intensive care unit admission as well as for in-hospital mortality. A subanalysis of patients with blood cultures (n = 7,482) demonstrated that blood urea nitrogen at intensive care unit admission was associated with the risk of blood culture positivity. Conclusion: Among critically ill patients with creatinine of 0.8-1.3 mg/dL, an elevated blood urea nitrogen was associated with increased mortality, independent of serum creatinine.
AB - Objective: We hypothesized that elevated blood urea nitrogen can be associated with all-cause mortality independent of creatinine in a heterogeneous critically ill population. Design: Multicenter observational study of patients treated in medical and surgical intensive care units. Setting: Twenty intensive care units in two teaching hospitals in Boston, MA. Patients: A total of 26,288 patients, age 18 yrs, hospitalized between 1997 and 2007 with creatinine of 0.80-1.30 mg/dL. Interventions: None. Measurements: Blood urea nitrogen at intensive care unit admission was categorized as 10-20, 20-40, and >40 mg/dL. Logistic regression examined death at days 30, 90, and 365 after intensive care unit admission as well as in-hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models. Main Results: Blood urea nitrogen at intensive care unit admission was predictive for short- and long-term mortality independent of creatinine. Thirty days following intensive care unit admission, patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 5.12 (95% confidence interval, 4.30-6.09; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Blood urea nitrogen remained a significant predictor of mortality at 30 days after intensive care unit admission following multivariable adjustment for confounders; patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 2.78 (95% confidence interval, 2.27-3.39; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Thirty days following intensive care unit admission, patients with blood urea nitrogen of 20-40 mg/dL had an odds ratio of 2.15 (95% confidence interval, 1.98-2.33; <.0001) and a multivariable odds ratio of 1.53 (95% confidence interval, 1.40-1.68; p < .0001) relative to patients with blood urea nitrogen of 10-20 mg/dL. Results were similar at 90 and 365 days following intensive care unit admission as well as for in-hospital mortality. A subanalysis of patients with blood cultures (n = 7,482) demonstrated that blood urea nitrogen at intensive care unit admission was associated with the risk of blood culture positivity. Conclusion: Among critically ill patients with creatinine of 0.8-1.3 mg/dL, an elevated blood urea nitrogen was associated with increased mortality, independent of serum creatinine.
KW - blood urea nitrogen
KW - creatinine
KW - gastrointestinal bleed
KW - intensive care
KW - mortality
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UR - http://www.scopus.com/inward/citedby.url?scp=79251577608&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e3181ffe22a
DO - 10.1097/CCM.0b013e3181ffe22a
M3 - Article
C2 - 21099426
AN - SCOPUS:79251577608
VL - 39
SP - 305
EP - 313
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 2
ER -