Matsue Yuya, van der Meer Peter, Damman Kevin, Metra Marco, O'Connor Christopher M, Ponikowski Piotr, Teerlink John R, Cotter Gad, Davison Beth, Cleland John G, Givertz Michael M, Bloomfield Daniel M, Dittrich Howard C, Gansevoort Ron T, Bakker Stephan J L, van der Harst Pim, Hillege Hans L, van Veldhuisen Dirk J, Voors Adriaan A
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Experimental and Clinical Medicine, University of Brescia, Brescia, Italy.
Heart. 2017 Mar;103(6):407-413. doi: 10.1136/heartjnl-2016-310112. Epub 2016 Sep 22.
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.
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.
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.
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.
血尿素氮与肌酐（BUN/肌酐）比值已被提出作为急性心力衰竭（AHF）的一个有用参数，但缺乏关于正常范围以及该比值与AHF患者中其单独成分相比的附加值的数据。本研究的目的是确定BUN/肌酐比值的正常范围，并研究其在AHF患者中的临床意义。
在4484名无心血管合并症的普通人群受试者中，我们计算了BUN/肌酐比值的年龄和性别特异性正常值，得出高于和低于正常范围的BUN/肌酐比值（超过95%预测区间）。在2033例AHF患者中，通过180天全因死亡、60天内死亡或心血管或肾脏再住院以及60天内心力衰竭（HF）再住院的结局，测试异常范围与预后的关联。
在一组AHF患者中，482例（24.6%）和28例（1.4%）HF患者分别被归类为高于和低于正常范围组。在Cox回归分析中，调整包括肌酐和BUN在内的其他预后因素后，BUN/肌酐比值高于正常范围组是全因死亡（HR：1.86，95%CI 1.29至2.66）和死亡或心血管或肾脏再住院（HR：1.37，95%CI 1.03至1.82）的独立预测因素，但不是HF再住院（HR：1.23，95%CI 0.81至1.86）的独立预测因素。
在AHF患者中，BUN/肌酐高于年龄和性别特异性正常范围与较差的预后相关，且独立于肌酐和BUN。临床试验：gov标识符NCT00328692和NCT00354458。
