Clinical value of blood urea nitrogen to creatinine ratio in evaluating long-term prognosis in patients with acute heart failure
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摘要: 目的:探究血尿素氮与肌酐比值(blood urea nitrogen to creatinine ratio,BUN/Cr)与急性心力衰竭(心衰)患者长期预后的相关性。方法:前瞻性分析2012年至2016年纳入本研究的462例因急性心衰发作于南京医科大学第一附属医院住院的患者。根据入院时BUN/Cr的四分位间距,将全部患者分为4组:Q1组(BUN/Cr<17.00,114例)、Q2组(17.00≤BUN/Cr<20.73,116例)、Q3组(20.73≤BUN/Cr<25.08,116例)及Q4组(BUN/Cr≥25.08,116例),并随访至2018年12月,定义主要终点事件为全因死亡,评估4组患者之间长期病死率有无差异,并绘制Kaplan-Meier生存曲线。对所有影响患者预后的变量行单因素分析,并将P<0.05的变量纳入Cox回归模型,对有可能影响患者预后的变量行亚组分析。结果:中位随访时间2.8[1.5,3.8]年,197例(42.6%)患者死亡,其中Q1组37例(18.8%),Q2组52例(26.4%),Q3组47例(23.9%),Q4组61例(31.0%)。随BUN/Cr增加,全因死亡发生率增加,4组间累积生存率差异有统计学意义(Log-rank:P=0.001)。多因素分析后,Cox回归模型显示,Q4组(BUN/Cr≥25.08)患者病死率是Q1组(BUN/Cr<17.00)患者的2.30倍[HR=2.30(1.40~3.79),P=0.001]。结论:BUN/Cr与急性心衰患者不良预后相关,是全因死亡的独立预测因素。Abstract: Objective:To investigate the correlation between blood urea nitrogen to creatinine ratio(BUN/Cr) and long-term prognosis in patients with acute heart failure(AHF).Method:This prospective study was conducted to analyze 462 patients admitted to the First Affiliated Hospital with Nanjing Medical University for acute heart failure from 2012 to 2016.According to the interquartile range of admission BUN/Cr,all patients were divided into 4 groups:Q1 group(BUN/Cr＜17.00,n=114),Q2 group(17.00≤BUN/Cr＜20.73,n=116),Q3 Group(20.73≤BUN/Cr＜25.08,n=116) and Q4 group(BUN/Cr≥25.08,n=116).All patients were followed up until March 2019.The primary endpoint event was defined as all-cause death.Then,the Kap-lan-Meier survival curve was drawn to evaluate whether there was a difference in long-term mor-tality between the four groups of patients.Univariate analysis was performed on all variables that affected patient outcomes.A variable of P＜0.05 was included in the Cox regression model.Result:The median follow-up time was 2.8[1.5,3.8] years.The 197 patients(42.6%) died,including 37 patients(18.8%) in the Q1 group,52 patients(26.4%) in the Q2 group,47 patients(23.9%) in the Q3 group,and 61 patients(31.0%) in the Q4 group.With the increase of BUN/Cr,the incidence of all-cause mortality increased,and the cumulative survival rate among the four groups was signifi-cantly different(Log-rank:P=0.001).After multivariate analysis,Cox regression model showed that the mortality rate of patients in Q4 group(BUN/Cr＜25.08) was 2.30 times higher than that of Q1 group(BUN/Cr＜17.00) [HR=2.30(1.40-3.79),P=0.001].In the subgroup analysis,there was a significant interaction between BUN/Cr and left ventricular ejection fraction(P=0.017) and between BUN/Cr and diabetes(P=0.027).Conclusion:The ratio of blood urea nitrogen to creati-nine is associated with poor prognosis in patients with acute heart failure and is an independent predictor of all-cause mortality.
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Key words:
- acute heart failure /
- blood urea nitrogen and creatinine ratio /
- mortality
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