Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of “normal” creatinine*

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Abstract

Objective:

We hypothesized that elevated blood urea nitrogen can be associated with all-cause mortality independent of creatinine in a heterogeneous critically ill population.

Design:

Multicenter observational study of patients treated in medical and surgical intensive care units.

Setting:

Twenty intensive care units in two teaching hospitals in Boston, MA.

Patients:

A total of 26,288 patients, age ≥18 yrs, hospitalized between 1997 and 2007 with creatinine of 0.80–1.30 mg/dL.

Interventions:

None.

Measurements:

Blood urea nitrogen at intensive care unit admission was categorized as 10–20, 20–40, and >40 mg/dL. Logistic regression examined death at days 30, 90, and 365 after intensive care unit admission as well as in-hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models.

Main Results:

Blood urea nitrogen at intensive care unit admission was predictive for short- and long-term mortality independent of creatinine. Thirty days following intensive care unit admission, patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 5.12 (95% confidence interval, 4.30–6.09; p < .0001) relative to patients with blood urea nitrogen of 10–20 mg/dL. Blood urea nitrogen remained a significant predictor of mortality at 30 days after intensive care unit admission following multivariable adjustment for confounders; patients with blood urea nitrogen of >40 mg/dL had an odds ratio for mortality of 2.78 (95% confidence interval, 2.27–3.39; p < .0001) relative to patients with blood urea nitrogen of 10–20 mg/dL. Thirty days following intensive care unit admission, patients with blood urea nitrogen of 20–40 mg/dL had an odds ratio of 2.15 (95% confidence interval, 1.98–2.33; <.0001) and a multivariable odds ratio of 1.53 (95% confidence interval, 1.40–1.68; p < .0001) relative to patients with blood urea nitrogen of 10–20 mg/dL. Results were similar at 90 and 365 days following intensive care unit admission as well as for in-hospital mortality. A subanalysis of patients with blood cultures (n = 7,482) demonstrated that blood urea nitrogen at intensive care unit admission was associated with the risk of blood culture positivity.

Conclusion:

Among critically ill patients with creatinine of 0.8–1.3 mg/dL, an elevated blood urea nitrogen was associated with increased mortality, independent of serum creatinine.

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