The association between blood urea nitrogen to creatinine ratio and mortality in patients with upper gastrointestinal bleeding

The role of BUN/creatinine ratio in determining the severity of gastrointestinal bleeding and bleeding localization

OBJECTIVE

The aim of the study is to evaluate an established biomarker such as blood urea nitrogen (BUN)/Creatinine ratio in predicting upper gastrointestinal bleeding versus lower GI and stratify its severity. The aim of this study is to evaluate the diagnostic performance in clinical practice and predestination as a prognostic factor, including admission to an intensive care unit (ICU) or mortality rate for BUN/Creatinine ratio.

METHODS

A total of 300 patients controlled in our hospital between January 2022 and January 2024 were evaluated retrospectively due to hospitalization by acute GI bleeding. Gastroscopy and/or colonoscopy were used to stratify patients into the upper or lower GI bleeding group. Data included demographic information, clinical presentation history and vital signs, comorbidity status, medication use, clinical outcomes and laboratory tests including hemoglobin, hematocrit, urea, creatinine levels and so on. The BUN/Creatinine ratio was determined and correlated with site as well as severity of bleeding. Statistical techniques, such as logistic regression and receiver operating characteristic (ROC) analysis, were used to assess the diagnostic performance of the ratio and to choose a cut-off value.

RESULTS

Among the 300 patients, 215 (71.7% had upper GI bleeding, and 85 (28.3% had lower GI bleeding. Hematemesis and melena were significantly associated with upper GI bleeding, whereas hematochezia was more common in lower GI bleeding. Patients with upper GI bleeding had significantly higher BUN, urea, and BUN/Creatinine ratios, while hemoglobin and hematocrit levels were lower. The optimal BUN/Creatinine cut-off value of 23.3 demonstrated high sensitivity (89.3%) and specificity (94.1%) for distinguishing between upper and lower GI bleeding. Multivariate analysis revealed BUN/Creatinine ratio, hematochezia and endoscopic intervention as an independent predictor of bleeding location. Patients with BUN/Creatinine ratio >23.3 showed increased frequency of red blood cell transfusion, endoscopic intervention, and mortality.

CONCLUSION

The BUN/Creatinine ratio is a sensitive, noninvasive biomarker for distinguishing between upper and lower GI bleed and severity. Its introduction into clinical practice may enhance the decision process and patient care, especially in critical care contexts. Additional research is indicated to confirm these results and to define standardized cut-off values for wider use.

Nomogram establishment for gastrointestinal bleeding prediction in ICU patients with traumatic brain injury based on the MIMIC-IV database

Objectives

This study aimed to develop a robust nomogram for predicting the occurrence of gastrointestinal bleeding (GIB) in patients with traumatic brain injury (TBI) during their ICU stay, thereby facilitating the optimization of intervention strategies and enabling personalized treatment approaches.

Methods

Patient data were extracted from the publicly available MIMIC-IV (Medical Information Mart for Intensive Care IV) database. In this retrospective cohort study, a total of 2,774 patients with traumatic brain injury (TBI) were included. A 7:3 ratio was applied to allocate patients into the training and validation cohorts. A LASSO logistic regression model was constructed using the training set to identify potential predictors of gastrointestinal bleeding (GIB). The selected features were subsequently utilized to develop a nomogram model. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results

A nomogram model comprising six variables-gender, blood urea nitrogen (BUN), Shock Index (SI), albumin, SOFA score, and diabetes mellitus-was developed. These variables were identified as independent risk factors for gastrointestinal bleeding (GIB) in patients with traumatic brain injury (TBI) (p < 0.05). The area under the receiver operating characteristic curve (AUC) for the derivation cohort and validation cohort was 0.8541 (95% CI: 0.833 to 0.911) and 0.8381 (95% CI: 0.752 to 0.863), respectively. The calibration curve demonstrated good agreement between the predicted probabilities and actual observations, while decision curve analysis (DCA) highlighted the clinical utility of the predictive model.

Conclusion

This study developed a predictive model for GIB in patients with TBI, which may assist clinicians in early identification of high-risk patients and help mitigate the burden of GIB in susceptible populations.

Association of blood urea nitrogen to creatinine ratio with incident type 2 diabetes mellitus: A retrospective cohort study in the Chinese population

Renal dysfunction can lead to insulin resistance and increase the incidence of type 2 diabetes mellitus (T2DM). The blood urea nitrogen to creatinine ratio (NCR) is a frequently used indicator to assess renal dysfunction and differentiate between prerenal and intrinsic renal injury. However, the association between NCR and T2DM in the Chinese population remains unclear. Hence, this study aimed to investigate the association between NCR and the incidence of T2DM in the Chinese population. The relationship between NCR and T2DM was examined using the Cox proportional hazards model and curve fitting techniques. In addition, a comprehensive set of sensitivity and subgroup analyses were performed. All results were presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Between 2010 and 2016, 189,416 Chinese people were recruited from the Rich Healthcare Group for this retrospective cohort study. Of the participants, 3755 (19.8%) were diagnosed with T2DM during the follow-up period. After full adjustment, the Cox proportional hazards model revealed a positive connection between NCR and the incidence of T2DM (HR = 1.03, 95% CI: 1.02-1.04, P < .001). Compared with individuals with lower NCR Q1 (≤13.536), the multivariate HR for NCR and T2DM in Q2 (13.536-16.256), Q3 (16.256-19.638), Q4 (>19.638) were 1.08 (0.98-1.19), 1.16 (1.05-1.28), 1.39 (1.26-1.53). The higher NCR groups (≥20) had a higher ratio of T2DM (HR = 1.28, 95% CI: 1.18-1.38, P < .001) than the lowest NCR group (<20). These findings were validated using sensitivity and subgroup analyses. In conclusion, this study found a positive and independent association between NCR and the incidence of T2DM after adjusting for confounding variables.

Diagnosis Value of the Blood Urea Nitrogen-to-Creatinine Ratio in Determining the Need for Intervention of Acute Upper Gastrointestinal Bleeding

INTRODUCTION

The blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BUN/Cr ratio) may be used to evaluate the need for intervention of acute upper gastrointestinal bleeding (AUGIB). This study aimed to explore the predictive value of the BUN/Cr ratio in the need for intervention of AUGIB.

METHODS

This retrospective observational study included patients with AUGIB in the hospital's emergency department between August 2019 and May 2023. The patients were grouped according to whether they underwent an intervention for AUGIB. Patients treated between August 2019 and May 2022 were selected as the training set and the others as the validation set.

RESULTS

A total of 466 patients (328 males, 138 females) with AUGIB were enrolled in the intervention group (n = 167) and the no-intervention group (n = 299). In the training set, multivariable logistic regression showed that the BUN/Cr ratio (odds ratio [OR]: 1.013, 95% confidence interval [CI]: 1.003-1.023, p = 0.009), hemoglobin (OR: 0.989, 95% CI: 0.981-0.997, p = 0.010), and a previous history of esophageal variceal bleeding (OR: 6.898, 95% CI: 3.989-11.929, p < 0.001) were independently associated with intervention for AUGIB. The area under receiver operating characteristic curve of BUN/Cr ratio and the prediction model based on logistic regression to predict the need for intervention of AUGIB were 0.604 (95% CI: 0.544-0.664) and 0.759 (95% CI: 0.706-0.812) in the training set and 0.634 (95% CI: 0.529, 0.740) and 0.708 (95% CI: 0.609, 0.806) in the validation set, respectively.

CONCLUSION

The BUN/Cr ratio was associated with the need for AUGIB intervention. Combining it with other parameters might improve its diagnostic value to predict the need for intervention of AUGIB.

Association between BUN/creatinine ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome: a single-centre retrospective cohort from the MIMIC database

OBJECTIVE

Recent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess the association between BUN/Cr ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome (ARDS).

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

1034 patients were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome of the study was in-hospital mortality, defined by the vital status at the time of hospital discharge (ie, survivors and non-survivors).

RESULTS

Of the total patients, 191 (18.5%) died in hospital. The median follow-up duration was 16.0 (8.3-26.6) days. The results showed that high level of BUN/Cr ratio was significantly associated with an increased risk of in-hospital mortality (15.54-21.43: HR=2.00, 95% CI: (1.18 to 3.38); >21.43: HR=1.76, 95% CI: (1.04 to 2.99)) of patients with trauma-related ARDS. In patients with trauma-related ARDS that aged ≥65 years old, male and female, Onychomycosis Severity Index (OSI)>98, Revised Trauma Score (RTS)>11, Simplified Acute Physiology Score II (SAPS-II)>37 and sequential organ failure assessment (SOFA) scores≤7, BUN/Cr ratio was also related to the increased risk of in-hospital mortality (all p<0.05). The predictive performance of BUN/Cr ratio for in-hospital mortality was superior to BUN or Cr, respectively, with the area under the curve of receiver operator characteristic curve at 0.6, and that association was observed in age, gender, OSI, RTS, SAPS-II and SOFA score subgroups.

CONCLUSION

BUN/Cr ratio may be a potential biomarker for the risk of in-hospital mortality of trauma-related ARDS, which may help the clinicians to identify high-risk individuals and to implement clinical interventions.

The blood urea nitrogen/creatinine (BUN/cre) ratio was U-shaped associated with all-cause mortality in general population

Objectives

This study aimed to explore the relationship between the blood urea nitrogen/creatinine (BUN/Cre) ratio and all-cause or cause-specific mortality in the general population.

Methods

Participants were enrolled from the National Health and Nutrition Examination Survey (NHANES) during 1999 to 2014. Baseline variables were acquired from questionnaires and examinations. Death status were ascertained from National Death Index records. Cox proportional hazards models with cubic spines were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) of all-cause mortality, cardiovascular and cancer mortality.

Results

A total of 42038 participants were enrolled in the study with a median 8.13 years of follow-up. Older people and women tend to have a higher BUN/Cre ratio. After multivariable adjustment, BUN/Cre ratio between 11.43 and 14.64 was associated with the lowest all-cause mortality compared with the participants with the lowest quartile (HR 0.83 [0.76, 0.91]; p < 0.001). The highest quartile of BUN/Cre ratio was associated with the lowest risk of cancer mortality (HR 0.64 [0.53, 0.78]; p < 0.001). Restricted cubic splines showed BUN/Cre was nonlinearly associated with all-cause mortality and linearly associated with cancer mortality.

Conclusions

This study confirmed a U-shape relationship between BUN/Cre ratio and all-cause mortality in the general population.

The risk factors for the recurrent upper gastrointestinal hemorrhage among acute peptic ulcer disease patients in Syria: A prospective cohort study

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a life-threatening medical emergency characterized by bleeding from the esophagus, stomach, or duodenum. This study aims to analyze the risk factors for upper gastrointestinal tract rebleeding among acute peptic ulcer patients.

METHODS

This is a cohort clinical study conducted between July 2018 and June 2020. Patients admitted or hospitalized because of UGIB or developed it during their hospital stay were included.s The patients were divided into two groups for the statistical analysis using Forrest's ulcer rebleeding risk classification. Group 1: Forrest 1a+1b+2a+2b, and group 2: Forrest 2c+3. The fasting time before the endoscopic procedure was from 12 to 24 hours. Follow-ups were conducted for 30 days after the treatment.

RESULTS

The total number of included subjects was 152, out of which 57.89% (n = 88) were male patients. The mean SD for patients' age was 52.63 16.89±; more than 40% (n = 62) of subjects were using antiplatelet medications, while only 13.15% (n = 20) used NSAIDs, and the mean SD for the transferred units was 2.32 ± 1.88, 7.24% (n = 11) of patients died. After 30 days of the treatment, 6.57% (n = 10) of patients suffered from recurrent bleeding. The most common presentation was melena 67.95% (n = 103), 53% (n = 81) of patients had hematemesis, 69.73% (n = 106) patients had gastric ulcer and 30.26% (n = 46) had duodenal ulcers.

CONCLUSION

Age, NSAIDs, altered mental capacity, Forrest classification (Ia,Ib, and IIa), and blood transfusion were associated with a higher risk of rebleeding. Furthermore, patients who needed 3.83 blood units were at higher risk of recurrent bleeding.

Prediction of acute kidney injury in ICU with gradient boosting decision tree algorithms

PURPOSE

To predict acute kidney injury (AKI) in a large intensive care unit (ICU) database.

MATERIALS AND METHODS

A total of 30,020 ICU admissions with 17,222 AKI episodes were extracted from the Medical Information Mart from Intensive Care (MIMIC)-III database. These were randomly divided into a training set and an independent testing set in a ratio of 4:1. Data pertaining to demographics, admission information, vital signs, laboratory tests, critical illness scores, medications, comorbidities, and intervention measures were collected. Logistic regression, random forest, LightGBM, XGBoost, and an ensemble model was used for early prediction of AKI occurrence and important feature extraction. The SHAP analysis was adopted to reveal the impact of prediction for each feature.

RESULTS

The ensemble model had the best overall performance for predicting AKI before 24 h, 48 h and 72 h. The F1 values were 0.915, 0.893, and 0.878, respectively. AUCs were 0.923, 0.903, and 0.895, respectively.

CONCLUSIONS

Based on readily available electronic medical record (EMR) data, gradient boosting decision tree models are highly accurate at early AKI prediction in critically ill patients.

Comparison of IVC diameter ratio, BUN/creatinine ratio and BUN/albumin ratio for risk prediction in emergency department patients

INTRODUCTION

Early prediction of patients' prognosis in the emergency department (ED) is important. Patients' conditions such as dehydration help predict prognosis. The ratio of serum blood urea nitrogen to creatinine (BUN/Cr ratio) and inferior vena cava (IVC) diameter is often used to determine dehydration. Also, serum albumin levels reflect nutritional conditions such as dehydration. In this study, we evaluated the performance of BUN/Cr ratio, IVC diameter ratio, and BUN/Albumin ratio as predictive markers for in-hospital mortality and ICU admission among various diseases in ED.

MATERIAL AND METHODS

This retrospective cohort study utilized data from patients who had abdominal and pelvic computed tomography (APCT) performed at our institution from 2015 to 2018. The measurement of IVC diameter from computed tomography, the BUN/Cr ratio, and the BUN/Albumin ratio were calculated. Differences in the performance among the BUN/Cr ratio, the IVC diameter ratio, and the BUN/Albumin ratio for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve.

RESULTS

A total of 914 patients were enrolled and 78 patients (8.5%) were admitted to the ICU, and 71 patients (7.8%) died during the clinical process. Multivariate logistic regression showed that only the BUN/Albumin ratio was a significant predictor of inhospital mortality and ICU admission.

CONCLUSION

Among dehydration markers the BUN/Albumin ratio is a simple and useful tool for predicting the outcomes of patients visiting the ED.