What is the clinical evidence from this study?

Study design: Case-Control. Population: Acute decompensated heart failure (n=60). Intervention: Acute kidney injury with high BUN/Cr ratio (Group IV) vs. Non-acute kidney injury with low BUN/Cr ratio (Group I). Primary outcome: Mortality (p=≤0.001).

September 5, 2023Open Access

The prognostic role of urea-to-creatinine ratio in patients with acute heart failure syndrome: a case–control study

Key Result

In patients with acute decompensated heart failure, acute kidney injury with an elevated BUN/Cr ratio was associated with a significantly higher mortality rate compared to non-AKI patients with a low BUN/Cr ratio (56.2% vs 4.0%).

Study Design

Type

Case-Control (n=60)

Multicenter

Structured PICO

Does an elevated BUN/Cr ratio predict mortality and MACE in patients with acute decompensated heart failure?

Population

60 adult patients with acute decompensated heart failure (HFrEF or HFpEF), mean age 62.8, 71.7% male, based in Egypt. Key exclusions: <18 years, pregnant, required renal replacement therapy, known obstructive uropathy, or known renal disease.

Intervention

High blood urea nitrogen-to-creatinine (BUN/Cr) ratio and acute kidney injury (AKI) status (observational exposure)

Comparator

Low BUN/Cr ratio and non-AKI status

Outcome

Patient outcome (MACE), length of hospitalization, and mortalityhard clinical

An elevated BUN/Cr ratio on admission in patients with acute decompensated heart failure is associated with a higher risk of acute kidney injury, MACE, and mortality.

Main Result

Absolute Event Rate: 56.2% vs 4%

p-value: p=≤0.001

Limitations

Observational nature of the study
Non-neurohormonal factors affecting the BUN/Cr ratio (e.g., high-protein diet, cachexia, muscular atrophy) were not examined
Time interval for serum creatinine tests was not strictly 48 hours, potentially underestimating AKI incidence
AKI was defined only by serum creatinine, without incorporating urine output criteria

Abstract

BACKGROUND: Recent research has shown that the blood urea/creatinine ratio (BUN/Cr) rather than BUN or Cr alone can predict the prognosis of individuals with acute heart failure (AHF). The objective of this study was to estimate the urea-to creatinine serum ratio (BUN/Cr) in patients with acute decompensated heart failure (ADHF) and correlate the results with patient outcome, length of hospitalization, and mortality. RESULTS: Sixty ADHF patients were included and categorized into four groups; Group I: non-AKI with low BUN/Cr (n = 25); Group II: non-AKI with high BUN/Cr (n = 5); Group III: AKI with low BUN/Cr (n = 14); Group IV: AKI with high BUN/Cr (n = 16). Regarding urea and BUN levels, the first reading showed a considerable rise in urea and BUN levels in groups III and IV compared to group 1 and in group IV compared to groups I and III. Similar results were recorded in the second and third readings. Regarding the BUN/Cr ratio, the three readings revealed a significant elevation in group IV compared to groups I and II and in group IV compared to group III. Mortality was significantly higher in group IV compared to group I. Additionally, MACE was significantly more frequent in group IV compared to groups I and III. Multivariable logistic regression analysis revealed that hypertension, creatinine, and BUN were independent predictors of AKI. CONCLUSIONS: BUN/Cr may predict prognosis in AHF patients since AHF with an elevated BUN/Cr is associated with a higher death rate.

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