The fallacy of the BUN:creatinine ratio in critically ill patients
In: Nephrology, dialysis, transplantation (Print), Jg. 27 (2012), Heft 6, S. 2248-2254
Online
academicJournal
- print, 40 ref
Zugriff:
Background and objectives. Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown. Methods. We conducted a retrospective observational study of two cohorts of critically ill patients admitted to a single center: a derivation cohort, in which AKI was diagnosed, and a larger validation cohort. We analyzed associations between BCR and clinical outcomes: mortality and renal replacement therapy (RRT). Results. Patients in the derivation cohort (N = 1010) with BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was significantly associated with increased mortality and a lower likelihood of RRT in all patients, patients with AKI and patients at risk for AKI. Patients in the validation cohort (N = 10 228) with a BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was associated with increased mortality and a lower likelihood of RRT in all patients and in those at risk for AKI, BUN correlated with age and severity of illness. Conclusions. A BCR >20 is associated with increased mortality in critically ill patients. It is also associated with a lower likelihood of RRT, perhaps because of misinterpretation of the BCR. Clinicians should not use a BCR >20 to classify AKI in critically ill patients.
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The fallacy of the BUN:creatinine ratio in critically ill patients
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Autor/in / Beteiligte Person: | RACHOIN, Jean-Sebastien ; DAHER, Ralph ; MOUSSALLEM, Charles ; MILCAREK, Barry ; HUNTER, Krystal ; SCHORR, Christa ; ABBOUD, Mariam ; HENRY, Patricia ; WEISBERG, Lawrence S |
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Zeitschrift: | Nephrology, dialysis, transplantation (Print), Jg. 27 (2012), Heft 6, S. 2248-2254 |
Veröffentlichung: | Oxford: Oxford University Press, 2012 |
Medientyp: | academicJournal |
Umfang: | print, 40 ref |
ISSN: | 0931-0509 (print) |
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