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Heart failure and cardiomyopathies
Original article
Blood urea nitrogen-to-creatinine ratio in the general population and in patients with acute heart failure
  1. Yuya Matsue1,
  2. Peter van der Meer1,
  3. Kevin Damman1,
  4. Marco Metra2,
  5. Christopher M O'Connor3,
  6. Piotr Ponikowski4,
  7. John R Teerlink5,
  8. Gad Cotter6,
  9. Beth Davison6,
  10. John G Cleland7,
  11. Michael M Givertz8,
  12. Daniel M Bloomfield9,
  13. Howard C Dittrich10,
  14. Ron T Gansevoort11,
  15. Stephan J L Bakker11,12,
  16. Pim van der Harst1,
  17. Hans L Hillege1,13,
  18. Dirk J van Veldhuisen1,
  19. Adriaan A Voors1
  1. 1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Department of Experimental and Clinical Medicine, University of Brescia, Brescia, Italy
  3. 3Inova Heart and Vascular Institute, Falls Church, Virginia, USA
  4. 4Medical University, Clinical Military Hospital, Wroclaw, Poland
  5. 5San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA
  6. 6Momentum Research, Durham, North Carolina, USA
  7. 7National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
  8. 8Brigham and Women's Hospital, Boston, Massachusetts, USA
  9. 9Merck Research Laboratories, Rahway, New Jersey, USA
  10. 10University of Iowa Carver College of Medicine Cardiovascular Research Center, Iowa City, Iowa, USA
  11. 11Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  12. 12Top Institute Food and Nutrition, Wageningen, The Netherlands
  13. 13Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Adriaan A Voors, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands; a.a.voors{at}umcg.nl

Abstract

Objective The blood urea nitrogen-to-creatinine (BUN/creatinine) ratio has been proposed as a useful parameter in acute heart failure (AHF), but data on the normal range and the added value of the ratio compared with its separate components in patients with AHF are lacking. The aim of this study is to define the normal range of BUN/creatinine ratio and to investigate its clinical significance in patients with AHF.

Methods In 4484 subjects from the general population without cardiovascular comorbidities, we calculated age-specific and sex-specific normal values of the BUN/creatinine ratio, deriving a higher and lower than normal range of BUN/creatinine ratio (exceeding the 95% prediction intervals). Association of abnormal range to prognosis was tested in 2033 patients with AHF for the outcome of all-cause death through 180 days, death or cardiovascular or renal rehospitalisation through 60 days and heart failure (HF) rehospitalisation within 60 days.

Results In a cohort of patients with AHF, 482 (24.6%) and 28 (1.4%) patients with HF were classified into higher and lower than normal range groups, respectively. In Cox regression analysis, higher than normal range of BUN/creatinine ratio group was an independent predictor for all-cause death (HR: 1.86, 95% CI 1.29 to 2.66) and death or cardiovascular or renal rehospitalisation (HR: 1.37, 95% CI 1.03 to 1.82), but not for HF rehospitalisation (HR: 1.23, 95% CI 0.81 to 1.86) after adjustment for other prognostic factors including both creatinine and BUN.

Conclusions In patients with AHF, BUN/creatinine higher than age-specific and sex-specific normal range is associated with worse prognosis independently from both creatinine and BUN.

Clinical Trials gov identifier NCT00328692 and NCT00354458

https://doi.org/10.1136/heartjnl-2016-310112

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