Prognostic impact of blood urea nitrogen/creatinine ratio changes in patients with acute ischemic stroke

Association Between Enhanced Hydration Therapy and Improved Prognosis in Patients With Acute Ischemic Stroke Who Were Treated With Thrombolytics: A Preliminary Study

Introduction: Hypovolemia affects the clinical outcomes and efficacy of thrombolytic therapies such as recombinant tissue plasminogen activator (rt-PA). Hence, it plays an essential role in stroke management. Blood urea nitrogen-to-creatinine ratio (BCR) is an indicator of hypovolemia and is a promising area of further investigation. Methods: This study assessed the efficacy of enhanced hydration therapy in patients with acute ischemic stroke (AIS) who had an elevated BCR and were receiving rt-PA treatment. The outcomes between patients with AIS who received enhanced hydration therapy (the study group) and those with AIS who received standard hydration therapy (the historical control group) were compared. Eligible patients received 0.9% NaCl intravenous infusion at a volume of 20 mL/kg body weight. Then, a bolus injection of one-third of the total volume was administered, and the remaining two-third was continuously infused over 8 h. Next, a maintenance infusion of 40-80 mL/h was administered within 16 h. The primary outcomes were 3-month functional recovery and early neurological deterioration. Results: This analysis included 20 patients with AIS and 170 historical controls. The study and historical control groups did not significantly differ in terms of demographic characteristics, baseline stroke severity, and biochemical parameters. However, the study group had a higher prevalence of hypertension than the historical control group. Further, the study group had significantly better 3-month functional outcomes than the historical control group (p=0.018). In particular, 45.0% of patients in the study group and 21.2% in the control group achieved a modified Rankin Scale score of ≤ 2. Based on a subgroup analysis, patients with a lower stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores of 4-10) in the study group exhibited significant improvements in functional outcomes. Meanwhile, patients with a higher stroke severity (NIHSS scores of 11-24) did not present with comparable benefits. The high stroke severity group had a higher complication rate than the low stroke severity group. However, the results did not significantly differ. Importantly, none of the patients who received enhanced hydration therapy developed adverse events. Conclusion: Enhanced hydration therapy can improve outcomes in patients with stroke who had an elevated BCR and who received rt-PA treatment. Further, it is not associated with significant complications.

Interaction between age and blood urea nitrogen to creatinine ratio on mortality in patients with severe cirrhosis: a retrospective cohort study from the MIMIC database

Background

Cirrhosis is a leading cause of global disease burden, with high mortality, particularly in critically ill patients. The blood urea nitrogen to creatinine ratio (BCR) is a straightforward biochemical indicator of renal excretory function and is linked to negative outcomes across different conditions. However, the relationship between BCR and mortality in critically ill patients with cirrhosis is unclear, The purpose of this study is to explore this question.

Methods

A retrospective cohort study was performed utilizing the MIMIC-IV database. We divided BCR into quartiles and evaluated 180-day and 365-day mortality as the primary outcomes. Kaplan-Meier survival analysis and multivariate Cox regression modeling were used to assess the link between BCR and mortality. Linear relationships were further determined using restricted cubic spline (RCS) curves, and finally, subgroup analyses were also performed.

Results

In our study of 2,816 critically ill cirrhotic patients, elevated BCR was significantly linked to higher mortality at both 180 and 365 days. The top BCR quartile showed a 45% higher risk of 180-day mortality (HR=1.45, 95% CI: 1.21-1.73) and a 38% higher risk of 365-day mortality (HR=1.38, 95% CI: 1.17-1.63) relative to the bottom quartile. RCS analysis demonstrated a notable linear correlation between BCR and mortality risk. Subgroup analyses indicated a stronger association between BCR and mortality among older patients.

Conclusion

In critically ill cirrhotic patients, elevated BCR values are strongly linked to increased mortality risk. Our research highlights BCR's potential as a prognostic marker for cirrhosis, especially in elderly patients.

Predicting mortality in heart failure: BUN/creatinine ratio in MIMIC-III

Aims

Heart failure is a critical health issue with high mortality rates. The blood urea nitrogen/creatinine ratio (BCR) has proven more effective at predicting outcomes in heart failure patients than individual assessments of each marker. Nevertheless, the implications of varying BCR levels for outcomes among heart failure patients remain to be fully understood. This study explores the impact of BCR on the outcomes of these patients.

Methods and results

Employing a retrospective cohort design at a single center, this study examined 1,475 heart failure patients from the Medical Information Mart for Intensive Care (MIMIC-III) database, categorized into four quartiles based on their BCR levels. We analyzed survival outcomes using Kaplan-Meier and Cox proportional hazards models, supplemented by restricted cubic splines to elucidate detailed associations. The average age of the patients was 69.52 years, with males constituting 55.6% of the cohort. As BCR values escalated, the average hospital stay increased from 9.64 to 14.15 days, and average survival decreased from 685.11 to 412.68 days. Patients in the highest BCR quartile faced the most severe mortality rates, with 18.8% in-hospital and 78.3% long-term mortality. Nonlinear regression revealed a U-shaped relationship between BCR and mortality: at BCR levels below 12.5, there was no significant correlation with long-term mortality; between 12.5 and 22, BCR appeared to exert a protective effect; and above 22, it emerged as a significant risk factor.

Conclusions

Admission BCR values are non-linearly associated with mortality in heart failure patients, suggesting its utility as a prognostic tool in critical care.

High Dose of Liraglutide Impairs Renal Function in Female Hypertensive Rats

ABSTRACT

Glucagon-like peptide-1 receptor agonists exhibit beneficial cardiovascular effects. However, the renal effects of different doses of liraglutide in an essential hypertension model have not yet been investigated. Female spontaneously hypertensive rats were treated for 30 days, twice a day, with saline (control) or liraglutide at low (0.06 mg/kg) and high (LH, 0.6 mg/kg) doses. Volume intake and excretion were monitored for a period of 24 hours. In renal tissue, nitrite, nitrate, advanced protein oxidation products, collagen deposition, creatinine (Cr), urea (U), sodium, and potassium were analyzed. Liraglutide reduced body weight gain in both groups. However, in the high dose, it increased urinary volume excretion and sodium/potassium ratio. Both doses reduced the urinary U/Cr ratio and LH increased the serum U/Cr ratio. Advanced protein oxidation products were reduced only in low liraglutide. LH augmented collagen and early markers of kidney injury (blood urea nitrogen, blood urea nitrogen/Cr). LH increased nitrate, reduced nitrite, and caused an aberrant increase in glomerular filtration rate. Both doses' effects were independent of blood pressure and glycemic control. Liraglutide appears to have distinct effects on the hypertensive female kidney depending on the dose, with higher doses impairing kidney function.

The association of blood urea nitrogen-to-creatinine ratio and in-hospital mortality in acute ischemic stroke patients with atrial fibrillation: data from the MIMIC-IV database

Objective

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).

Methods

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.

Results

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, p = 0.004). A non-linear J-shaped relationship was observed between BUN/Cr at ICU admission and in-hospital mortality rate (p = 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, p = 0.012).

Conclusion

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.

Acute kidney injury with intravenous colistin sulfate compared with polymyxin B in critically ill patients: A real-world, retrospective cohort study

BACKGROUND

Polymyxins have re-emerged as a last-resort therapeutic option for infections caused by carbapenem-resistant gram-negative bacteria. Nephrotoxicity induced by polymyxins is a significant limitation of its use in the clinic. Polymyxin B and colistin sulfate are two widely used active formulations of polymyxins. However, there is a lack of studies conducting a comparative assessment of nephrotoxicity between the two formulations. This study aimed to compare the nephrotoxicity of polymyxin B and colistin sulfate in critically ill patients.

METHODS

We conducted a retrospective cohort study among critically ill patients who received intravenous polymyxin B or colistin sulfate for over 48 h from January 2017 to January 2024. The primary outcome was the incidence of acute kidney injury (AKI) associated with polymyxins, and the secondary outcome was 30-day all-cause mortality. Additionally, the risk factors of polymyxins-induced AKI and 30-day all-cause mortality were identified by Cox proportional hazard regression analysis.

RESULTS

A total of 473 patients were included in this study. The overall incidence of AKI was significantly higher in patients who received polymyxin B compared to those who received colistin sulfate in the unmatched cohort (20.8% vs. 9.0%, p = 0.002) and in the propensity score matching cohort (21.1% vs. 7.0%, p = 0.004), respectively. However, there was no significant difference in 30-day all-cause mortality between the two groups. Polymyxin type, septic shock, and concomitant use of vasopressors were identified as independent risk factors for polymyxin-induced AKI.

CONCLUSIONS

The prevalence of AKI was higher among patients who received polymyxin B compared to those treated with colistin sulfate. However, there was no significant difference in 30-day all-cause mortality between the two groups. Further prospective, multicenter studies with larger sample sizes are needed to validate these findings.

Association between the blood urea nitrogen-to-creatinine ratio and 3-month outcomes in patients with acute ischemic stroke: a secondary analysis based on a prospective cohort study

Introduction

This study aimed to assess the correlation between the blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio and adverse outcomes (AOs) at 3 months in patients with acute ischemic stroke (AIS) in the Korean population.

Methods

This cohort study encompassed 1906 cases of AIS at a South Korean hospital from January 2010 to December 2016. To determine the linear correlation between the BUN/Cr ratio and AOs in AIS, a binary logistic regression model (BLRM) was employed. Additionally, generalized additive models and techniques for smooth curve fitting were utilized to reveal the nonlinear dynamics between the BUN/Cr ratio and AOs in patients with AIS.

Results

The prevalence of AOs was 28.65%, with a median BUN/Cr ratio of 18.96. Following adjustments for covariates, the BLRM disclosed that the association between the BUN/Cr ratio and the risk of AOs in patients with AIS did not attain statistical significance. Nevertheless, a nonlinear relationship surfaced, pinpointing an inflection point at 21.591. To the left of this inflection point, a 31.42% reduction in the risk of AOs was noted for every 1-unit surge in the Z score of the BUN/Cr ratio [odds ratio (OR) = 0.686, 95% confidence interval (CI): 0.519, 0.906, p = 0.008]. On the right side of the inflection point, the effect size (OR = 1.405, 95% CI: 1.018, 1.902, p = 0.039) was determined.

Conclusion

The findings of this study underscore the intricate nature of the relationship between the BUN/Cr ratio and 3-month outcomes in patients with AIS, establishing a robust groundwork for future investigations.

Effect of Clemastine on Neurophysiological Outcomes in an Ovine Model of Neonatal Hypoxic-Ischemic Encephalopathy

Originally approved by the U.S. Food and Drug Administration (FDA) for its antihistamine properties, clemastine can also promote white matter integrity and has shown promise in the treatment of demyelinating diseases such as multiple sclerosis. Here, we conducted an in-depth analysis of the feasibility, safety, and neuroprotective efficacy of clemastine administration in near-term lambs (n = 25, 141-143 days) following a global ischemic insult induced via an umbilical cord occlusion (UCO) model. Lambs were randomly assigned to receive clemastine or placebo postnatally, and outcomes were assessed over a six-day period. Clemastine administration was well tolerated. While treated lambs demonstrated improvements in inflammatory scores, their neurodevelopmental outcomes were unchanged.

Interpretable machine learning for prediction of clinical outcomes in acute ischemic stroke

Background and aims

Predicting the prognosis of acute ischemic stroke (AIS) is crucial in a clinical setting for establishing suitable treatment plans. This study aimed to develop and validate a machine learning (ML) model that predicts the functional outcome of AIS patients and provides interpretable insights.

Methods

We included AIS patients from a multicenter stroke registry in this prognostic study. ML-based methods were utilized to predict 3-month functional outcomes, which were categorized as either favorable [modified Rankin Scale (mRS) ≤ 2] or unfavorable (mRS ≥ 3). The SHapley Additive exPlanations (SHAP) method was employed to identify significant features and interpret their contributions to the predictions of the model.

Results

The dataset comprised a derivation set of 3,687 patients and two external validation sets totaling 250 and 110 patients each. Among them, the number of unfavorable outcomes was 1,123 (30.4%) in the derivation set, and 93 (37.2%) and 32 (29.1%) in external sets A and B, respectively. Among the ML models used, the eXtreme Gradient Boosting model demonstrated the best performance. It achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.790 (95% CI: 0.775-0.806) on the internal test set and 0.791 (95% CI: 0.733-0.848) and 0.873 (95% CI: 0.798-0.948) on the two external test sets, respectively. The key features for predicting functional outcomes were the initial NIHSS, early neurologic deterioration (END), age, and white blood cell count. The END displayed noticeable interactions with several other features.

Conclusion

ML algorithms demonstrated proficient prediction for the 3-month functional outcome in AIS patients. With the aid of the SHAP method, we can attain an in-depth understanding of how critical features contribute to model predictions and how changes in these features influence such predictions.

Mean Platelet Volume/Platelet Count Ratio as a Predictor of Both Incidence and Prognosis of Acute Ischemic Stroke in Hemodialysis Patients

Purpose

This study aimed to explore whether the mean platelet volume/platelet count ratio (MPR) has predictive value for the occurrence and prognosis of acute ischemic stroke (AIS) in hemodialysis patients.

Patients and Methods

A total of 402 patients undergoing maintenance hemodialysis were screened and 259 were enrolled in this study. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive power of the models. The patients enrolled in this study were divided into three groups based on the tertiles of the MPR value (Q1, Q2, and Q3). Kaplan-Meier curves were used to investigate the association between the MPR and AIS-free survival in hemodialysis patients. Chi-square analysis was performed to explore the association between the MPR and AIS outcomes in hemodialysis patients. And the AIS outcome was assessed using the modified Rankin Scale (mRS).

Results

MPR had a predictive value for the occurrence of AIS (AUC=0.814) in hemodialysis patients with a high sensitivity and specificity. AIS-free survival rates in the MPR Q1, MPR Q2, and MPR Q3 groups were 0.930, 0.701, and 0.360, respectively. The proportion of patients with good outcomes (mRS 0-2) was significantly greater among patients in the MPR Q1-Q2 group than in the MPR Q3 group (0.844 vs 0.745, p <0.001).

Conclusion

The MPR can be used as a good predictor of AIS in patients undergoing hemodialysis. Patients on hemodialysis with increased MPR levels had a higher incidence of AIS and poorer functional outcomes than those with low MPR levels.

Relationship between the Blood Urea Nitrogen to Creatinine Ratio and In-Hospital Mortality in Non-Traumatic Subarachnoid Hemorrhage Patients: Based on Propensity Score Matching Method

(1) Background: To explore the correlation between the blood urea nitrogen to creatinine ratio (UCR) and in-hospital mortality in non-traumatic subarachnoid hemorrhage patients. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive Ⅳ (MIMIC-Ⅳ) database. The optimal cut-off value of the UCR was calculated with ROC curve analysis conducted using the maximum Youden index for the prediction of survival status. Univariable and multivariable logistic regression analyses were also carried out to assess the prognostic significance of UCR, and the Kaplan−Meier (K−M) analysis was conducted to draw the survival curves. Then, the 1:1 propensity score matching (PSM) method was applied to improve the reliability of the research results while balancing the unintended influence of underlying confounders. (3) Results: This retrospective cohort study included 961 patients. The optimal cut-off value of the UCR for in-hospital mortality was 27.208. The PSM was performed to identify 92 pairs of score-matched patients, with balanced differences exhibited for nearly all variables. According to the K−M analysis, those patients with a UCR of more than 27.208 showed a significantly higher level of in-hospital mortality compared to the patients with a UCR of less than 27.208 (p < 0.05). After the adjustment for possible confounders, those patients whose UCR was more than 27.208 still had a significantly higher level of in-hospital mortality than the patients whose UCR was less than 27.208, as revealed by the multivariable logistic regression analysis (OR = 3.783, 95% CI: 1.959~7.305, p < 0.001). Similarly, the in-hospital mortality remained substantially higher for those patients in the higher UCR group than for the patients in the lower UCR group after PSM. (4) Conclusion: A higher level of the UCR was evidently associated with an increased risk of in-hospital mortality, which made the ratio useful as a prognostic predictor of clinical outcomes for those patients with non-traumatic subarachnoid hemorrhage.