Emergency Medicine Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
Emergency Medicine Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
Am J Emerg Med. 2021 Aug;46:349-354. doi: 10.1016/j.ajem.2020.10.008. Epub 2020 Oct 10.
In this study, we aimed to evaluate the first measured blood urea nitrogen (BUN)/albumin ratio in the emergency department (ED) as a predictor of in-hospital mortality in older ED patients.
This retrospective observational study was conducted at a university hospital ED. Consecutive patients aged 65 and over who visited the ED in a three-month period were included in the study. The BUN, albumin, creatinine, and estimated glomerular filtration rate (eGFR) of patients were recorded. The primary end point of the study was in-hospital mortality.
A total of 1253 patients were included in the statistical analyses of the study. Non-survivors had increased BUN levels (32.9 (23.3-55.4) vs. 20.2 (15.4-28.3) mg/dL, p < 0.001), decreased albumin levels (3.27 (2.74-3.75) vs. 3.96 (3.52-4.25) g/dL, p < 0.001), and increased BUN/albumin ratios (10.19 (6.56-18.94) vs. 5.21 (3.88-7.72) mg/g, p < 0.001) compared to survivors. An increased BUN/albumin ratio was a powerful predictor of in-hospital mortality with an area under the curve of 0.793 (95% CI: 0.753-0.833). Malignancy (OR: 2.39; 95% CI: 1.59-3.74, p < 0.001), albumin level < 3.5 g/dL (OR: 2.75; 95% CI: 1.74-4.36, p < 0.001), and BUN/albumin ratio > 6.25 (OR: 2.82; 95% CI: 1.22-6.50, p < 0.015) were found to be independent predictors of in-hospital mortality in older ED patients.
According to our findings, older patients with a BUN level > 23 mg/dL, an albumin level < 3.5 g/dL, and a BUN/albumin ratio > 6.25 mg/g in the ED have a higher risk of in-hospital mortality. Additionally, the BUN/albumin ratio is a more powerful independent predictor of in-hospital mortality than the BUN level, albumin level, creatinine level, and eGFR in older ED patients.
本研究旨在评估急诊（ED）中首次测量的血尿素氮（BUN）/白蛋白比值作为老年 ED 患者住院死亡率的预测指标。
这是一项在大学医院 ED 进行的回顾性观察性研究。在三个月期间，纳入了年龄在 65 岁及以上并在 ED 就诊的连续患者。记录患者的 BUN、白蛋白、肌酐和估算肾小球滤过率（eGFR）。本研究的主要终点是住院死亡率。
共有 1253 名患者纳入本研究的统计分析。与幸存者相比，非幸存者的 BUN 水平升高（32.9（23.3-55.4）vs. 20.2（15.4-28.3）mg/dL，p<0.001），白蛋白水平降低（3.27（2.74-3.75）vs. 3.96（3.52-4.25）g/dL，p<0.001），BUN/白蛋白比值升高（10.19（6.56-18.94）vs. 5.21（3.88-7.72）mg/g，p<0.001）。升高的 BUN/白蛋白比值是住院死亡率的有力预测指标，曲线下面积为 0.793（95%CI：0.753-0.833）。恶性肿瘤（OR：2.39；95%CI：1.59-3.74，p<0.001）、白蛋白水平<3.5 g/dL（OR：2.75；95%CI：1.74-4.36，p<0.001）和 BUN/白蛋白比值>6.25（OR：2.82；95%CI：1.22-6.50，p<0.015）是老年 ED 患者住院死亡率的独立预测因素。
根据我们的发现，ED 中 BUN 水平>23 mg/dL、白蛋白水平<3.5 g/dL 和 BUN/白蛋白比值>6.25 mg/g 的老年患者住院死亡率较高。此外，BUN/白蛋白比值是比 BUN 水平、白蛋白水平、肌酐水平和 eGFR 更强大的独立预测因素，可预测老年 ED 患者的住院死亡率。
