Casas Aparicio Gustavo, Fernández Plata Rosario, Higuera Iglesias Anjarath, Martínez Briseño David, Claure-Del Granado Rolando, Castillejos Lopez Manuel, Vázquez Pérez Joel, Alvarado Vásquez Noé, Velázquez Cruz Rafael, Hernández Silva Graciela, Ruiz Victor, Camarena Ángel, Salinas Lara Citlaltepetl, Tena Suck Martha, Montes de Oca Ambriz Iñaki, Ortiz Toledo Oswaldo, Arvizu Serrano Vianey, Almazan Chaparro Yared, Flores-Soto Edgar, Torres-Espíndola Luz María, Aquino-Gálvez Arnoldo, Ahumada Topete Victor Hugo
Titular de la Coordination de Nefrología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Ciudad de México, 14080, México.
Unidad de Epidemiología Hospitalaria e Infectología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Col. Sección XVI, Ciudad de México, 14080, CP, México.
Pneumonia (Nathan). 2024 Oct 25;16(1):20. doi: 10.1186/s41479-024-00140-0.
Patients with COVID-19 may experience a persistent increase in the blood urea nitrogen over creatinine ratio (PI-BUN/Cr). Its elevation could reflect multiple underlying pathophysiological processes beyond prerenal injury but also warrants nuanced interpretation due to its complex interplay with various factors, underscoring the importance of investigating its effects on mortality and acute kidney injury in this population.
We analized a retrospective and longitudinal cohort of patients admitted to a single center in Mexico City for patients with severe COVID-19. Between March 5, 2020 and August 25, 2021, we included patients with confirmed positive diagnosis for SARS-CoV-2, age > 18 years, disease severity was defined by clinical data of respiratory distress syndrome and a ratio of partial oxygen pressure to inspired oxygen fraction < 300 mmHg on admission. We excluded patients with End Stage Kidney Disease. Data was obtained from electronic medical records. PI-BUN/Cr was defined as an increase in the BUN/Cr ratio > 30 in more than 60% of measurements in the hospital. The outcomes included: risk factors to mortality and AKI in-hospital.
The cohort included 3,007 patients with a median age of 54.6 ± 14.5 years. 35% of patients died; 44.6% developed PI-BUN/Cr ratio and 71.4% AKI. Mortality was associated with older age > 60 years [Hazard ratio (HR)] = 1.45, 95% CI: 1.28-1.65; p < 0.001); male (HR 1.25, 95% CI 1.09-1.44; p = 0.002) and AKI (HR 3.29, 95% CI 2.42-4.46; p < 0.001); PI-BUN/CR & Non-AKI (HR = 2.82, 95% CI: 1.61-4.93; p < 0.001); Non PI-BUN/CR & AKI (HR = 5.47, 95% CI: 3.54-8.44; p < 0.001); and PI-BUN/CR & AKI (HR = 4.26, 95% CI: 2.75-6.62, p < 0.001). Only hiperuricemia was a risk factor for AKI (HR = 1.71, 95% CI: 1.30-2.25, p < 0.001).
While PI-BUN/Cr alone may not directly associate with mortality, its capacity to sub-phenotype patients according to their AKI status holds significant promise in offering valuable insights into patient prognosis and outcomes. Understanding the nuanced relationship between PI-BUN/Cr and AKI enhances our comprehension of renal function dynamics. It equips healthcare providers with a refined tool for risk stratification and personalized patient management strategies.
新型冠状病毒肺炎（COVID-19）患者的血尿素氮与肌酐比值（PI-BUN/Cr）可能持续升高。其升高可能反映了肾前性损伤以外的多种潜在病理生理过程，但由于其与多种因素的复杂相互作用，仍需要细致解读，这凸显了研究其对该人群死亡率和急性肾损伤影响的重要性。
我们分析了墨西哥城一家单一中心收治的重症COVID-19患者的回顾性纵向队列。在2020年3月5日至2021年8月25日期间，我们纳入了确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、年龄>18岁的患者，疾病严重程度根据呼吸窘迫综合征的临床数据以及入院时氧分压与吸入氧分数之比<300 mmHg来定义。我们排除了终末期肾病患者。数据来自电子病历。PI-BUN/Cr定义为住院期间超过60%的测量中BUN/Cr比值升高>30。结局包括：住院期间死亡和急性肾损伤的危险因素。
该队列包括3007例患者，中位年龄为54.6±14.5岁。35%的患者死亡；44.6%出现PI-BUN/Cr比值升高，71.4%发生急性肾损伤。死亡率与年龄>60岁相关[风险比（HR）=1.45，95%置信区间（CI）：1.28-1.65；p<0.001]；男性（HR 1.25，95%CI 1.09-1.44；p=0.002）和急性肾损伤（HR 3.29，95%CI 2.42-4.46；p<0.001）；PI-BUN/CR与非急性肾损伤（HR=2.82，95%CI：1.61-4.93；p<0.001）；非PI-BUN/CR与急性肾损伤（HR=5.47，95%CI：3.54-8.44；p<0.001）；以及PI-BUN/CR与急性肾损伤（HR=4.26，95%CI：2.75-6.62，p<0.001）。只有高尿酸血症是急性肾损伤的危险因素（HR=1.71，95%CI：1.30-2.25，p<0.001）。
虽然单独的PI-BUN/Cr可能与死亡率无直接关联，但其根据患者急性肾损伤状态进行亚表型分类的能力在提供有关患者预后和结局的有价值见解方面具有重要前景。了解PI-BUN/Cr与急性肾损伤之间的细微关系可增强我们对肾功能动态的理解。它为医疗保健提供者提供了一种更精细的风险分层工具和个性化的患者管理策略。
