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Blood urea nitrogen - independent marker of mortality in sepsis

Martin Harazim1,2,3, Kaiquan Tan4, Marek Nalos1,4,5

  • 1ICU, Department of Internal Medicine I, Faculty of Medicine, Charles University and University Hospital Pilsen, Czech Republic.

Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
|April 4, 2022
PubMed

Insights

High admission Blood Urea Nitrogen (BUN) levels in sepsis patients predict a greater risk of 28-day mortality. This easily measured biomarker can aid in predicting outcomes for critically ill sepsis patients.

Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Epidemiology

Background:

  • Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
  • Early identification of patients at high risk of mortality is crucial for timely intervention.
  • Blood Urea Nitrogen (BUN) is a commonly measured laboratory parameter in critically ill patients.

Purpose of the Study:

  • To investigate the association between admission Blood Urea Nitrogen (BUN) levels and 28-day mortality in patients with sepsis.
  • To determine if BUN is an independent predictor of mortality in this population.

Main Methods:

  • Retrospective analysis of 9126 sepsis patients from two cohorts (Czech Republic and United States) between January 2014 and December 2018.
  • Kaplan-Meier survival analysis and Cox regression models were employed.
  • An optimal BUN cut-off for predicting 28-day mortality was determined using the Youden Index.

Main Results:

  • Admission BUN levels were categorized into 10-20, 20-40, and >40 mg/dL.
  • Patients with the highest BUN levels (>40 mg/dL) had a significantly increased hazard ratio (HR) for 28-day mortality (2.764) compared to the lowest levels (10-20 mg/dL).
  • An optimal BUN cut-off of 23 mg/dL was identified for predicting 28-day mortality. This association remained significant after adjusting for confounders like APACHE IV, SAPS2, and eGFR.

Conclusions:

  • Admission Blood Urea Nitrogen (BUN) is a valuable and readily available independent predictor of 28-day mortality in critically ill sepsis patients.
  • Elevated BUN levels at ICU admission are associated with poorer clinical outcomes in sepsis.
  • This finding supports the routine use of BUN for risk stratification in sepsis management.
Abstract

Keywords:
BUNbig datamortalitysepsisurea

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