Clinical implications of persistently increased blood urea nitrogen/serum creatinine ratio (PI-BUN/Cr) in severe COVID-19 patients.

IF 8.5 Q1 RESPIRATORY SYSTEM Pneumonia Pub Date : 2024-10-25 DOI:10.1186/s41479-024-00140-0
Gustavo Casas Aparicio, Rosario Fernández Plata, Anjarath Higuera Iglesias, David Martínez Briseño, Rolando Claure-Del Granado, Manuel Castillejos Lopez, Joel Vázquez Pérez, Noé Alvarado Vásquez, Rafael Velázquez Cruz, Graciela Hernández Silva, Victor Ruiz, Ángel Camarena, Citlaltepetl Salinas Lara, Martha Tena Suck, Iñaki Montes de Oca Ambriz, Oswaldo Ortiz Toledo, Vianey Arvizu Serrano, Yared Almazan Chaparro, Edgar Flores-Soto, Luz María Torres Espíndola, Arnoldo Aquino-Gálvez, Victor Hugo Ahumada Topete
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Abstract

Background: Patients with COVID-19 may experience a persistent increase in the blood urea nitrogen over creatinine ratio (PI-BUN/Cr). Its elevation could reflect multiple underlying pathophysiological processes beyond prerenal injury but also warrants nuanced interpretation due to its complex interplay with various factors, underscoring the importance of investigating its effects on mortality and acute kidney injury in this population.

Methods: We analized a retrospective and longitudinal cohort of patients admitted to a single center in Mexico City for patients with severe COVID-19. Between March 5, 2020 and August 25, 2021, we included patients with confirmed positive diagnosis for SARS-CoV-2, age > 18 years, disease severity was defined by clinical data of respiratory distress syndrome and a ratio of partial oxygen pressure to inspired oxygen fraction < 300 mmHg on admission. We excluded patients with End Stage Kidney Disease. Data was obtained from electronic medical records. PI-BUN/Cr was defined as an increase in the BUN/Cr ratio > 30 in more than 60% of measurements in the hospital. The outcomes included: risk factors to mortality and AKI in-hospital.

Results: The cohort included 3,007 patients with a median age of 54.6 ± 14.5 years. 35% of patients died; 44.6% developed PI-BUN/Cr ratio and 71.4% AKI. Mortality was associated with older age > 60 years [Hazard ratio (HR)] = 1.45, 95% CI: 1.28-1.65; p < 0.001); male (HR 1.25, 95% CI 1.09-1.44; p = 0.002) and AKI (HR 3.29, 95% CI 2.42-4.46; p < 0.001); PI-BUN/CR & Non-AKI (HR = 2.82, 95% CI: 1.61-4.93; p < 0.001); Non PI-BUN/CR & AKI (HR = 5.47, 95% CI: 3.54-8.44; p < 0.001); and PI-BUN/CR & AKI (HR = 4.26, 95% CI: 2.75-6.62, p < 0.001). Only hiperuricemia was a risk factor for AKI (HR = 1.71, 95% CI: 1.30-2.25, p < 0.001).

Conclusions: While PI-BUN/Cr alone may not directly associate with mortality, its capacity to sub-phenotype patients according to their AKI status holds significant promise in offering valuable insights into patient prognosis and outcomes. Understanding the nuanced relationship between PI-BUN/Cr and AKI enhances our comprehension of renal function dynamics. It equips healthcare providers with a refined tool for risk stratification and personalized patient management strategies.

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严重 COVID-19 患者血尿素氮/血清肌酐比值(PI-BUN/Cr)持续升高的临床意义。
背景:COVID-19 患者的血尿素氮与肌酐比值(PI-BUN/Cr)可能会持续升高。它的升高可能反映了肾前损伤以外的多种潜在病理生理过程,但由于其与各种因素的复杂相互作用,也需要进行细致的解释,这就强调了研究其对该人群死亡率和急性肾损伤影响的重要性:我们对墨西哥城一家中心收治的重症 COVID-19 患者进行了回顾性和纵向队列分析。在 2020 年 3 月 5 日至 2021 年 8 月 25 日期间,我们纳入了确诊为 SARS-CoV-2 阳性、年龄大于 18 岁的患者,疾病严重程度由呼吸窘迫综合征临床数据和医院 60% 以上测量的氧分压与吸入氧分压比值 30 来定义。结果包括:死亡率和院内 AKI 的风险因素:该队列包括 3,007 名患者,中位年龄为(54.6 ± 14.5)岁。35%的患者死亡;44.6%出现PI-BUN/Cr比值,71.4%出现AKI。死亡率与年龄大于 60 岁有关 [危险比 (HR)] = 1.45,95% CI:1.28-1.65;P 结论:虽然 PI-BUN/Cr 本身可能与死亡率没有直接关系,但它能根据患者的 AKI 状态对患者进行亚型分型,为了解患者的预后和治疗效果提供了重要依据。了解 PI-BUN/Cr 和 AKI 之间的微妙关系能增强我们对肾功能动态的理解。它为医疗服务提供者提供了风险分层和个性化患者管理策略的完善工具。
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来源期刊
Pneumonia
Pneumonia RESPIRATORY SYSTEM-
自引率
1.50%
发文量
7
审稿时长
11 weeks
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