ICU, Department of Internal Medicine I, Faculty of Medicine, Charles University and University Hospital Pilsen, Czech Republic.
Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023 Mar;167(1):24-29. doi: 10.5507/bp.2022.015. Epub 2022 Mar 30.
This retrospective study examines the relationship between admission Blood Urea Nitrogen (BUN) levels and clinical outcomes in patients with sepsis from two separate cohorts in the Czech Republic and the United States.
The study included 9126 patients with sepsis between January 2014 and December 2018. Kaplan-Meier survival curves and Cox regression were used to analyse the data. An optimal cut-off was calculated by means of the Youden-Index.
BUN at ICU admission was categorized as 10-20, 20-40 and >40 mg/dL. Comparing the group with the highest BUN levels to the one with lowest levels, we found HR for 28 days mortality 2.764 (CI 95% 2.37-3.20; P<0.001). We derived an optimal cut-off for prediction of 28 days mortality of 23 mg/dL. The association between BUN and 28 days mortality remained significant after adjusting for potential confounders - for APACHE IV (HR 1.374; 95%CI 1.20-1.58; P<0.001), SAPS2 (HR 1.545; 95%CI 1.35-1.77; P<0.001), eGFR (HR 1.851; 95%CI 1.59-2.16; P<0.001) and several other variables in an integrative model.
Our findings support the BUN level as an independent and easily available predictor of 28 days mortality in septic critically ill patients admitted to an ICU.
本回顾性研究考察了捷克共和国和美国两个独立队列中脓毒症患者入院时血尿素氮（BUN）水平与临床结局的关系。
本研究纳入了 2014 年 1 月至 2018 年 12 月期间的 9126 例脓毒症患者。采用 Kaplan-Meier 生存曲线和 Cox 回归分析数据。通过 Youden 指数计算最佳截断值。
将 ICU 入院时的 BUN 分为 10-20、20-40 和>40mg/dL。与 BUN 水平最低的组相比，我们发现 28 天死亡率的 HR 为 2.764（95%CI 2.37-3.20；P<0.001）。我们得出了预测 28 天死亡率的最佳截断值为 23mg/dL。在调整潜在混杂因素后，BUN 与 28 天死亡率之间的关联仍然显著——APACHE IV（HR 1.374；95%CI 1.20-1.58；P<0.001）、SAPS2（HR 1.545；95%CI 1.35-1.77；P<0.001）、eGFR（HR 1.851；95%CI 1.59-2.16；P<0.001）和综合模型中的其他几个变量。
我们的研究结果支持 BUN 水平作为 ICU 收治的脓毒症危重症患者 28 天死亡率的独立且易于获得的预测指标。
