High BUN-to-Creatinine ratio improves in-hospital survival of critical patients of cardiogenic shock

China: In a new study conducted by Di Sun and the team it was shown that regardless of acute kidney injury (AKI) status, a high BUN-to-Cr ratio (BCR) was associated with better in-hospital survival for patients with cardiogenic shock (CS). The findings of this study were published in BMC Cardiovascular Disorders.

Cardiogenic shock is defined as insufficient forward tissue perfusion and severe reverse congestion caused by cardiac pump inefficiency. Despite recent advances in critical care unit technology and therapy for CS, the in-hospital death rate remains high. Regardless of the fact that blood urea nitrogen (BUN) and serum creatinine concentration (Cr) are commonly monitored in everyday clinical practice, the BUN-to-Cr ratio for prognosis in patients hospitalized with cardiogenic shock is unclear. As a result, the current study was carried out to evaluate the predictive efficacy of BCR on CS.

Data for patients with CS were gathered from the Medical Information Mart's public database for Intensive Care-III (1137 individuals with CS, including 556 in the low BCR (20) group and 581 in the high BCR (20) group). In-hospital mortality was the primary outcome. 

The key findings of this study were as follows:

1. In the multivariate Cox model and Kaplan–Meier curve, researchers discovered that high BCR was independently related to significantly better in-hospital survival for CS compared to low BCR.

2. The advantage of high BCR on in-hospital survival for CS persisted across AKI and non-AKI categories.

"In patients with CS, a greater level BCR at admission was independently connected with decreased in-hospital mortality. Meanwhile, whether patients had AKI or not, the robust outcome of in-hospital survival for the high BCR group remained consistent. These findings must be validated in the future by a major prospective experiment," said the authors.

Reference:

Sun, D., Wei, C., & Li, Z. (2022). Blood urea nitrogen to creatinine ratio is associated with in-hospital mortality among critically ill patients with cardiogenic shock. BMC Cardiovascular Disorders, 22(1), 258. https://doi.org/10.1186/s12872-022-02692-9