July 31, 2023Open Access
Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis
Key Result
High blood urea nitrogen levels were associated with a 2.29-fold increased risk of all-cause mortality in patients with heart failure compared to low levels.
Study Design
Type
Meta-Analysis (n=56,003)
Structured PICO
Does high blood urea nitrogen predict all-cause mortality in patients with heart failure?
P
Population
56,003 patients with heart failure from 19 cohort studies
I
Intervention
High levels of blood urea nitrogen (BUN) or continuous increase in BUN
C
Comparator
Low levels of blood urea nitrogen (BUN)
O
Outcome
All-cause mortality (risk of death)hard clinical
High blood urea nitrogen is an independent predictor of all-cause mortality in patients with heart failure, suggesting its utility as a prognostic biomarker.
Main Result
Effect estimate: RR 2.29 (95% CI 1.42-3.70)
p-value: p=<0.001
Limitations
- The type of heart failure varied among the independent studies included, which is a source of clinical variation
- Multifactorial analysis was not performed in some studies, so whether blood urea nitrogen is an independent predictor remains to be discussed
- Patients in these studies were followed up at different time points, which is a source of variability
Abstract
Background The mortality rate of patients with heart failure (HF) remains high, and when heart failure occurs, blood urea nitrogen (BUN) is involved in the perfusion of renal blood flow. Some studies have shown an association between heart failure prognosis and blood urea nitrogen, but the results of some other studies were inconsistent. Therefore, we conducted a comprehensive meta-analysis to investigate the value of BUN on the prognosis of patients with heart failure. Methods A computerized systematic search of all English literature was performed in four databases, PubMed, Cochrane, Embase and Web of Science, from their inception to May 2022. The data of BUN were classified into continuous and categorical variables after passing the inclusion and exclusion criteria. The BUN data of both types were extracted separately into stata15.0 for statistical analysis. Results A total of 19 cohort studies involving 56,003 patients were included. When BUN was used as a categorical variable, the risk of death in heart failure was 2.29 times higher for high levels of BUN than for low levels of BUN ( RR = 2.29, 95% CI:1.42–3.70, P 0.001). The results showed statistical significance in multifactorial and univariate groups, the prospective cohort, and European and Asian groups. When BUN was used as a continuous variable, the risk of death in heart failure was 1.02 times higher for each unit increase in BUN ( RR = 1.02, 95% CI:1.01–1.03, p 0.001). Subgroup analysis showed statistical significance in retrospective cohort, American and Asian. Conclusion High BUN is an independent predictor of all-cause mortality in heart failure. Lower BUN was associated with better prognosis in patients with heart failure.