Li Bowen, Li Juan, Meng Xin, Yang Shu, Tian Furong, Song Xiang, Liu Junjie
College of Clinical Medicine, North China University of Science and Technology, Tangshan, China.
College of Basic Medical Sciences, North China University of Science and Technology, Tangshan, China.
Front Neurol. 2024 Aug 7;15:1331626. doi: 10.3389/fneur.2024.1331626. eCollection 2024.
This research aimed to investigate the association between the blood urea nitrogen-to-creatinine (BUN/Cr) ratio and the rate of in-hospital mortality in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF), who are also receiving care in intensive care unit (ICU).
A retrospective study was conducted using the MIMIC-IV database. We collected data on BUN/Cr levels at admission for patients with AIS and concurrent AF. To assess the association between BUN/Cr and in-hospital mortality rate, statistical analysis was conducted employing multivariable logistic regression models and restricted cubic spline models. These models were utilized to investigate the potential relationship and provide insights into the impact of BUN/Cr on the likelihood of in-hospital mortality. Interaction and subgroup analyses were performed to evaluate the consistency of the correlation.
There were a total of 856 patients (age ≥ 18 years) with a median age of 78.0 years, of which 466 (54.4%) were female. Out of 856 patients, 182 (21.26%) died in the hospital. Upon controlling for confounding factors, the multivariable logistic regression analysis elucidated that patients falling within the third trisection (Q3 > 22.41 mg/dL) exhibited a noticeably increased susceptibility to in-hospital mortality when contrasted with their counterparts positioned in the second trisection (Q2: 17.2-22.41 mg/dL) (OR = 2.02, 95% CI: 1.26-3.26, = 0.004). A non-linear J-shaped relationship was observed between BUN/Cr at ICU admission and in-hospital mortality rate ( = 0.027), with a turning point at 19.63 mg/dL. In the threshold analysis, there was a 4% rise in in-hospital mortality for each 1 mg/dL increase in BUN/Cr (OR: 1.04, 95% CI: 1.01-1.06, = 0.012).
In patients with AIS complicated by AF, BUN/Cr at admission shows a J-shaped correlation with in-hospital mortality rate. When BUN/Cr exceeds 19.63 mg/dL, the in-hospital mortality rate increases.
本研究旨在调查急性缺血性卒中（AIS）合并心房颤动（AF）且在重症监护病房（ICU）接受治疗的患者的血尿素氮与肌酐比值（BUN/Cr）与院内死亡率之间的关联。
使用MIMIC-IV数据库进行一项回顾性研究。我们收集了AIS合并AF患者入院时的BUN/Cr水平数据。为评估BUN/Cr与院内死亡率之间的关联，采用多变量逻辑回归模型和受限立方样条模型进行统计分析。这些模型用于研究潜在关系，并深入了解BUN/Cr对院内死亡可能性的影响。进行交互作用和亚组分析以评估相关性的一致性。
共有856例年龄≥18岁的患者，中位年龄为78.0岁，其中466例（54.4%）为女性。在856例患者中，182例（21.26%）在医院死亡。在控制混杂因素后，多变量逻辑回归分析表明，处于第三个三分位数（Q3＞22.41mg/dL）的患者与处于第二个三分位数（Q2：17.2 - 22.41mg/dL） 的患者相比，院内死亡易感性显著增加（OR = 2.02，95%CI：[1.26, 3.26]，P = 0.004）。在ICU入院时的BUN/Cr与院内死亡率之间观察到非线性J形关系（P = 0.027），转折点为19.63mg/dL。在阈值分析中，BUN/Cr每升高1mg/dL，院内死亡率上升4%（OR：1.04，95%CI：[1.01, 1.06]，P = 0.012）。
在AIS合并AF的患者中，入院时的BUN/Cr与院内死亡率呈J形相关性。当BUN/Cr超过19.63mg/dL时，院内死亡率增加。
