Key result
High levels of blood urea nitrogen significantly predicted in-hospital mortality in patients with acute myocardial infarction compared to low levels (adjusted OR 2.59).
Why the study?
Does a high level of blood urea nitrogen predict in-hospital mortality in patients with acute myocardial infarction?
Observational (n=2,995)
Yes
Does a high level of blood urea nitrogen predict in-hospital mortality in patients with acute myocardial infarction?
Odds Ratio: 2.59 (95% CI 1.57–4.25)
Absolute Event Rate: 11% vs 2.5%
p-value: p=<0.001
High blood urea nitrogen levels at admission are an independent predictor of in-hospital mortality in patients with acute myocardial infarction.
High BUN may identify higher in-hospital mortality risk in AMI; extends HF observations but remains hypothesis-generating.
High levels of blood urea nitrogen (BUN) have been demonstrated to significantly predict poor prognosis in patients with acute decompensated heart failure. However, this relationship has not been fully investigated in patients with acute myocardial infarction (AMI). We investigated whether a high level of BUN is a significant predictor for in-hospital mortality and other clinical outcomes in patients with AMI. The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective, observational, multicenter study conducted in 28 institutions, in which 3,283 consecutive AMI patients were enrolled. We excluded 98 patients in whom BUN levels were not recorded at admission and 190 patients who were undergoing hemodialysis. A total of 2,995 patients were retrospectively analyzed. BUN tertiles were 1.5-14.4 mg/dL (tertile 1), 14.5-19.4 mg/dL (tertile 2), and 19.5-240 mg/dL (tertile 3). Increasing tertiles of BUN were associated with stepwise increased risk of in-hospital mortality (2.5, 5.1, and 11%, respectively; P < 0.001). These relationships were also observed after adjusting for reduced estimated glomerular filtration rate (estimated GFR < 60 mL/minute/1.73 m2) or Killip classifications. In multivariable analysis, high levels of BUN significantly predicted in-hospital mortality, after adjusting for creatinine and other known predictors (BUN tertile 3 versus 1, adjusted odds ratio [OR]: 2.59, 95% confidence interval [95% CI]: 1.57-4.25, P < 0.001; BUN tertile 2 versus 1, adjusted OR: 1.60, 95% CI: 0.94-2.73, P = 0.081). A high level of BUN could be a useful predictor of in-hospital mortality in AMI patients.
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Horiuchi et al. (2018) conducted an observational in Acute Myocardial Infarction (n=2,995). High blood urea nitrogen (BUN) level (Tertile 3: 19.5-240 mg/dL) vs. Low blood urea nitrogen (BUN) level (Tertile 1: 1.5-14.4 mg/dL) was evaluated on In-hospital mortality (Adjusted OR 2.59, 95% CI 1.57-4.25, p=<0.001). High levels of blood urea nitrogen significantly predicted in-hospital mortality in patients with acute myocardial infarction compared to low levels (adjusted OR 2.59).
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