Blood Urea Nitrogen/Creatinine Ratio As a Predictor of 1-Year Survival in Patients with Acute Heart Failure: An Insight from HF Registry in National Cardiovascular Center Harapan Kita

Author : J.O. Santoso, A.R. Hidayat, H. Safitri, B. A. Marsudi, Danny, P. Almazini, B.B. Siswanto, R.P. Soera
Upload Date : 19-04-2018

Introduction: Heart Failure is known to be caused by excessive activation of neurohormonal system resulting in structural and functional disorder of the heart. This phenomenon not only affects the heart but also other organs e.g kidney. BUN/Cr ratio is known to reflect excessive activation and treatment inadequacy which in turn may affect the survival of patients with heart failure.

Aim: This study aims to investigate BUN/Cr Ratio as a predictor of mortality in patients with heart failure.

Method: This single-center retrospective cohort study was conducted using data from ESC-HF registry performed at NCCHK Jakarta in 2016. From 433 patients with acute heart failure (AHF), 266 subjects were included in the study. Clinical profile and entry BUN/Cr value was subsequently recorded. Cut-off point of BUN/Cr was obtained using C-Statistics and defined that patients with BUN/Cr > 24 as a high risk group. The primary outcome was death followed in 1-year after index hospitalization.

Result: Patients with BUN/Cr>24 significantly older (p<0.001) and lower systolic-diastolic blood pressure (p=0.028 and p=0.008). No significant difference in entry heart rate, entry ECG, diabetic status, and sex between two groups. Patients with high BUN/Cr ratio had higher length of stay (LOS) (p=0.002) and higher mortality (p=0.006). In 1-year survival assessment, patients with BUN/Cr ratio >24 had lower survival rate [Log-rank=0.002, HR=2.71 (CI95% 1.38-5.30), p=0.003]. When adjusted by age, systolic, and diastolic BP in index admission, HR was 2.93 (CI95% 1.32-6.51), p=0.008.

Conclusion: Patients with BUN/Cr>24 had longer LOS and worse 1-year survival rate that BUN/Cr ratio could be considered as predictor of mortality in patients with acute heart failure.

KEYWORDS : Acute Heart Failure, BUN/Cr ratio, 1-year survival, Length-of-stay

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