Zhu Xu, Cheang Iokfai, Liao Shengen, Wang Kai, Yao Wenming, Yin Ting, Lu Xinyi, Zhou Yanli, Zhang Haifeng, Li Xinli
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,
Cardiorenal Med. 2020;10(6):415-428. doi: 10.1159/000509834. Epub 2020 Oct 28.
To further explore the relationship between the blood urea nitrogen to creatinine (BUN/Cr) ratio and the prognosis of patients with acute heart failure (AHF), a two-part study consisting of a prospective cohort study and meta-analysis were conducted.
A total of 509 hospitalized patients with AHF were enrolled and followed up. Cox proportional hazards regression was used to analyze the relationship between the BUN/Cr ratio and the long-term prognosis of patients with AHF. Meta-analysis was also conducted regarding the topic by searching PubMed and Embase for relevant studies published up to October 2019.
During a median follow-up of 2.8 years, 197 (42.6%) deaths occurred. The cumulative survival rate of patients with a BUN/Cr ratio in the bottom quartile was significantly lower than in the other 3 groups (log-rank test: p = 0.003). In multivariate Cox regression models, the mortality rate of AHF patients with a BUN/Cr ratio in the bottom quartile was significantly higher than in the top quartile (adjusted HR 1.52; 95% CI 1.03-2.24). For the meta-analysis, we included 8 studies with 4,700 patients, consisting of 7 studies from the database and our cohort study. The pooled analysis showed that the highest BUN/Cr ratio category was associated with an 77% higher all-cause mortality than the lowest category (pooled HR 1.77; 95% CI 1.52-2.07).
Elevated BUN/Cr ratio is associated with poor prognosis in patients with AFH and is an independent predictor of all-cause mortality.
为进一步探究血尿素氮与肌酐比值（BUN/Cr）和急性心力衰竭（AHF）患者预后之间的关系，开展了一项分为两部分的研究，包括一项前瞻性队列研究和荟萃分析。
共纳入509例住院的AHF患者并进行随访。采用Cox比例风险回归分析BUN/Cr比值与AHF患者长期预后之间的关系。还通过检索PubMed和Embase数据库，查找截至2019年10月发表的相关研究，对该主题进行荟萃分析。
在中位随访2.8年期间，发生197例（42.6%）死亡。BUN/Cr比值处于最低四分位数的患者累积生存率显著低于其他三组（对数秩检验：p = 0.003）。在多变量Cox回归模型中，BUN/Cr比值处于最低四分位数的AHF患者死亡率显著高于最高四分位数的患者（校正风险比1.52；95%置信区间1.03 - 2.24）。对于荟萃分析，我们纳入了8项研究共4700例患者，其中包括来自数据库的7项研究和我们的队列研究。汇总分析显示，BUN/Cr比值最高组的全因死亡率比最低组高77%（汇总风险比1.77；95%置信区间1.52 - 2.07）。
BUN/Cr比值升高与AFH患者预后不良相关，是全因死亡率的独立预测因素。
