Department of Cadre Health Care, Fourth People's Hospital of Shenyang, Shenyang, 110031, China.
Sci Rep. 2018 Sep 10;8(1):13507. doi: 10.1038/s41598-018-31059-4.
Blood urea nitrogen (BUN) is a surrogate marker for neurohormonal activation, but the association between BUN and the post-discharge prognosis in elderly patients with acute decompensated heart failure (ADHF) is not well defined. We explored the association between BUN and post-discharge all-cause mortality in 652 elderly patients (73.9 ± 7.8 yr) with ADHF. All patients were followed for a mean duration of 32 months (12-69 months). BUN was analyzed both as a continuous variable and according to two categories: low BUN group (BUN < 15.35 mmol/L, N = 361) and high BUN group (BUN ≥ 15.35 mmol/L, N = 291). The risk of all-cause mortality increased by 1.6% per 1 mmol/L increase in BUN concentration when BUN was used as a continuous variable [hazard ratio (HR): 1.016, 95% confidence interval (CI): 1.006-1.026, p = 0.002]. BUN maintained an independent and significant positive correlation with all-cause mortality as a categorical variable (HR: 1.355, 95% CI: 1.023-1.794, p = 0.034 for the high BUN group). The BUN C-statistic for predicting all-cause mortality was 0.624 (95% CI: 0.585-0.661). The cut-off value for BUN was 15.35 mmol/L with sensitivity of 0.58 and specificity of 0.63. The prognostic performance of BUN was similar to brain natriuretic peptide (BNP) for predicting all-cause mortality (C-statistic: z = 0.044, p = 0.965). These results suggest that BUN is an independent predictor of post-discharge all-cause mortality in elderly patients with ADHF and its prognostic performance was similar to that of BNP.
血尿素氮（BUN）是神经激素激活的替代标志物，但 BUN 与老年急性失代偿性心力衰竭（ADHF）患者出院后的预后之间的关系尚不清楚。我们探讨了 BUN 与 652 名老年（73.9±7.8 岁）ADHF 患者出院后全因死亡率之间的关系。所有患者的平均随访时间为 32 个月（12-69 个月）。BUN 既作为连续变量进行分析，也根据两个类别进行分析：低 BUN 组（BUN＜15.35mmol/L，N=361）和高 BUN 组（BUN≥15.35mmol/L，N=291）。当 BUN 作为连续变量时，BUN 浓度每增加 1mmol/L，全因死亡率增加 1.6%[风险比（HR）：1.016，95%置信区间（CI）：1.006-1.026，p=0.002]。BUN 作为分类变量与全因死亡率呈独立且显著正相关（HR：1.355，95%CI：1.023-1.794，p=0.034 高 BUN 组）。BUN 预测全因死亡率的 C 统计量为 0.624（95%CI：0.585-0.661）。BUN 的截断值为 15.35mmol/L，敏感性为 0.58，特异性为 0.63。BUN 的预后性能与脑利钠肽（BNP）预测全因死亡率相似（C 统计量：z=0.044，p=0.965）。这些结果表明，BUN 是老年 ADHF 患者出院后全因死亡率的独立预测因子，其预后性能与 BNP 相似。
