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Does blood urea nitrogen-to-creatinine ratio predict outcomes in decompensated heart failure?
Session:
Posters (Sessão 2 - Écran 4) - Insuficiência Cardíaca 2 - Índices e Factores de Prognóstico
Speaker:
João Borges Rosa
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Borges Rosa; Sofia s. Martinho; José Lopes de Almeida; Joana Guimarães; Diogo de Almeida Fernandes; Eric Alberto Monteiro; Gonçalo Ferraz Costa; Gustavo m. Campos; Ana Rita m. Gomes; Patrícia m. Alves; Manuel Oliveira-Santos; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Renal dysfunction is common in patients with heart failure. The blood urea nitrogen-to-creatinine ratio (BUN/SCr) increase in the setting of a prerenal stressor as hypoperfusion of the kidneys, as a consequence of neurohormonal activation and it has been proposed as a prognostic marker in the acute setting. We aimed to evaluate whether BUN/SCr predicts mortality outcomes in a large contemporaneous real-world Southern European population with decompensated chronic heart failure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We retrospectively studied 1057 patients with chronic heart failure admitted to our emergency department between November 2016 and December 2017 with acute decompensation. Baseline clinical and analytical data were collected. We excluded patients without BUN or SCr values at admission and those with a glomerular filtration rate (GFR) <15mL/min/m<sup>2</sup> (calculated by the MDRD equation) or on dialysis. The incidence of rehospitalization and cardiovascular (CV) or all-cause death was evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 1025 patients were included, median age 80 years (IQR 73-85), 52.4% male (n=537), mean left ventricle ejection fraction (LVEF) 42.8 ± 12.7%, and mean GFR 57.2 ± 23.9 mL/min/m<sup>2</sup>. Mean BUN/SCr was 24.9 ± 8.2 and mean systolic blood pressure was 139 ± 29mmHg, both showing negative correlation (r=-0.17, p<0.001). There was no correlation between BUN/SCr and the length of hospitalization (r=0.058, p=0.18). After a median follow-up of 5 months (IQR 3-11 months), cardiovascular mortality and all-cause mortality occurred in 8.0% (n=82) and 21.6% (n=221), respectively. Mean BUN/SCr was higher in patients with fatal outcomes both for cardiovascular (31.3 vs. 24.3, p<0.001) and all-cause mortality (28.6 vs. 23.8, p<0.001). BUN/Scr was grouped by terciles: T1 (BUN/SCr <20.78), T2 (BUN/Scr 20.78-27.15), and T3 (BUN/Scr >27.15). In the T3 group, the multivariable-adjusted odds ratio (OR) for CV death and all-cause mortality was 5.43 (95% CI 2.20-13.37, p<0.01) and 2.72 (95% CI 1.66-4.46, p<0.01), respectively, compared to the T1 group. There were no significant differences between T1 and T2 groups. Kaplan-Meier estimates of CV and all-cause mortality during follow-up according to BUN/SCr tercile are shown in Figure 1.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: BUN/SCr at admission predicts CV and all-cause death in patients with chronic heart failure after an episode of decompensation. We hypothesize that BUN/SCr, as an easy-to-use tool, might help to identify those patients who benefit from tight monitoring both during hospitalization and after discharge.</span></span></p>
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