Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2023 Jul 13;18:1445-1455. doi: 10.2147/COPD.S412106. eCollection 2023.
High blood urea nitrogen (BUN) is observed in a subset of patients with acute exacerbation of COPD (AECOPD) and may be linked to clinical outcome, but findings from previous studies have been inconsistent.
We performed a retrospective analysis of patients prospectively enrolled in the MAGNET AECOPD Registry study (ChiCTR2100044625). Receiver operating characteristic (ROC) was used to determine the level of BUN that discriminated survivors and non-survivors. Univariate and multivariate Cox proportional hazards regression analyses were performed to assess the impact of BUN on adverse outcomes.
Overall, 13,431 consecutive inpatients with AECOPD were included in this study, of whom 173 died, with the mortality of 1.29%. The non-survivors had higher levels of BUN compared with the survivors [9.5 (6.8-15.3) vs 5.6 (4.3-7.5) mmol/L, P < 0.001]. ROC curve analysis showed that the optimal cutoff of BUN level was 7.30 mmol/L for in-hospital mortality (AUC: 0.782; 95% CI: 0.748-0.816; P < 0.001). After multivariate analysis, BUN level ≥7.3 mmol/L was an independent risk factor for in-hospital mortality (HR = 2.099; 95% CI: 1.378-3.197, P = 0.001), also for invasive mechanical ventilation (HR = 1.540; 95% CI: 1.199-1.977, P = 0.001) and intensive care unit admission (HR = 1.344; 95% CI: 1.117-1.617, P = 0.002). Other independent prognostic factors for in-hospital mortality including age, renal dysfunction, heart failure, diastolic blood pressure, pulse rate, PaCO2 and D-dimer.
BUN is an independent risk factor for in-hospital mortality in inpatients with AECOPD and may be used to identify serious (or severe) patients and guide the management of AECOPD.
MAGNET AECOPD; Chinese Clinical Trail Registry NO.: ChiCTR2100044625; Registered March 2021, URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.
在一部分急性加重期慢性阻塞性肺疾病（AECOPD）患者中可观察到高血尿素氮（BUN），且其可能与临床结局相关，但以往的研究结果并不一致。
我们对前瞻性纳入 MAGNET AECOPD 登记研究（ChiCTR2100044625）的患者进行了回顾性分析。采用受试者工作特征（ROC）曲线确定区分存活者和非存活者的 BUN 水平。采用单因素和多因素 Cox 比例风险回归分析评估 BUN 对不良结局的影响。
共有 13431 例连续住院的 AECOPD 患者纳入本研究，其中 173 例死亡，死亡率为 1.29%。与存活者相比，非存活者的 BUN 水平更高[9.5（6.8-15.3）vs 5.6（4.3-7.5）mmol/L，P<0.001]。ROC 曲线分析显示，BUN 水平的最佳截断值为 7.30 mmol/L 时预测院内死亡率的曲线下面积（AUC）为 0.782（95%CI：0.748-0.816，P<0.001）。多因素分析后，BUN 水平≥7.3 mmol/L 是院内死亡率的独立危险因素（HR=2.099，95%CI：1.378-3.197，P=0.001），也是有创机械通气（HR=1.540，95%CI：1.199-1.977，P=0.001）和入住重症监护病房（HR=1.344，95%CI：1.117-1.617，P=0.002）的独立危险因素。院内死亡率的其他独立预后因素包括年龄、肾功能不全、心力衰竭、舒张压、脉搏率、PaCO2 和 D-二聚体。
BUN 是 AECOPD 住院患者院内死亡率的独立危险因素，可用于识别重症（或严重）患者并指导 AECOPD 的管理。
MAGNET AECOPD；中国临床试验注册中心编号：ChiCTR2100044625；注册日期：2021 年 3 月，网址：http://www.chictr.org.cn/showproj.aspx?proj=121626。
