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Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Predicting mortality in heart failure: BUN/creatinine ratio in MIMIC-III
Changsen Zhu1, Liyan Wu1, Yiyi Xu2
1Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Insights
The blood urea nitrogen/creatinine ratio (BCR) shows a U-shaped association with mortality in heart failure patients. Higher BCR levels above 22 significantly increase mortality risk, while lower levels may offer a protective effect.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Heart failure (HF) is a major cause of mortality worldwide.
- The blood urea nitrogen/creatinine ratio (BCR) is a potential biomarker for HF outcomes.
- Understanding the precise relationship between BCR and HF prognosis is crucial.
Purpose of the Study:
- To investigate the impact of varying blood urea nitrogen/creatinine ratio (BCR) levels on mortality in heart failure patients.
- To determine the prognostic value of BCR in critical care settings for heart failure.
Main Methods:
- Retrospective cohort study of 1,475 heart failure patients from the MIMIC-III database.
- Patients categorized into four quartiles based on admission BCR levels.
- Survival outcomes analyzed using Kaplan-Meier and Cox proportional hazards models, with restricted cubic splines for nonlinear associations.
Main Results:
- Increasing BCR levels correlated with longer hospital stays and decreased survival.
- The highest BCR quartile exhibited significantly higher in-hospital (18.8%) and long-term (78.3%) mortality.
- A U-shaped relationship was observed: no significant mortality risk below BCR 12.5, a potential protective effect between 12.5-22, and increased risk above 22.
Conclusions:
- Admission BCR demonstrates a nonlinear association with mortality in heart failure.
- BCR serves as a valuable prognostic tool for predicting outcomes in critically ill heart failure patients.
- Specific BCR thresholds indicate varying risk levels, guiding clinical management.
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.
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