TY - JOUR
T1 - Prognostic Value of Blood Urea Nitrogen in Patients Hospitalized With Worsening Heart Failure
T2 - Insights From the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) Study
AU - Filippatos, Gerasimos
AU - Rossi, Joseph
AU - Lloyd-Jones, Donald M
AU - Stough, Wendy Gattis
AU - Ouyang, John
AU - Shin, David D.
AU - O'Connor, Christopher
AU - Adams, Kirkwood F.
AU - Orlandi, Cesare
AU - Gheorghiade, Mihai
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007/6
Y1 - 2007/6
N2 - Background: Hospitalization for acute decompensated heart failure (ADHF) is associated with a high postdischarge mortality and readmission rate. The association between baseline blood urea nitrogen (BUN) and clinical outcomes in patients admitted for ADHF was evaluated in a post-hoc analysis of the ACTIV in CHF trial. Methods and Results: Patients were categorized into quartiles according to baseline BUN. Cox proportional hazards regression was used to test the association between BUN, mortality, and death or readmission within 60 days. Patients in the highest quartile (>40 mg/dL) had the highest 60-day mortality (14.3%, 9.3%, 4.0%, 0%, respectively; P < .001) and the highest rate of death or heart failure hospitalization (30.0%, 21.3% 18.4%, 8.6%; P < .001). After adjustment for covariates, BUN was a statistically significant predictor of both mortality and the composite endpoint of death or heart failure hospitalization at 60 days after hospital discharge. Serum creatinine and estimated creatinine clearance did not predict mortality after covariate adjustment. Conclusions: Higher baseline BUN is a powerful predictor of increased postdischarge mortality in patients hospitalized for heart failure, even in the absence of severe renal failure. Even mild to moderate elevations in baseline BUN were predictive. BUN remains an easily accessible risk stratification tool that physicians should closely monitor in the hospital setting.
AB - Background: Hospitalization for acute decompensated heart failure (ADHF) is associated with a high postdischarge mortality and readmission rate. The association between baseline blood urea nitrogen (BUN) and clinical outcomes in patients admitted for ADHF was evaluated in a post-hoc analysis of the ACTIV in CHF trial. Methods and Results: Patients were categorized into quartiles according to baseline BUN. Cox proportional hazards regression was used to test the association between BUN, mortality, and death or readmission within 60 days. Patients in the highest quartile (>40 mg/dL) had the highest 60-day mortality (14.3%, 9.3%, 4.0%, 0%, respectively; P < .001) and the highest rate of death or heart failure hospitalization (30.0%, 21.3% 18.4%, 8.6%; P < .001). After adjustment for covariates, BUN was a statistically significant predictor of both mortality and the composite endpoint of death or heart failure hospitalization at 60 days after hospital discharge. Serum creatinine and estimated creatinine clearance did not predict mortality after covariate adjustment. Conclusions: Higher baseline BUN is a powerful predictor of increased postdischarge mortality in patients hospitalized for heart failure, even in the absence of severe renal failure. Even mild to moderate elevations in baseline BUN were predictive. BUN remains an easily accessible risk stratification tool that physicians should closely monitor in the hospital setting.
KW - Heart failure
KW - blood urea nitrogen
KW - morbidity
KW - mortality
KW - prognosis
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U2 - 10.1016/j.cardfail.2007.02.005
DO - 10.1016/j.cardfail.2007.02.005
M3 - Article
C2 - 17602982
AN - SCOPUS:34250807676
SN - 1071-9164
VL - 13
SP - 360
EP - 364
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 5
ER -