Blood Urea Nitrogen Is Associated with In-Hospital Mortality in Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis

Mohan Giri; Lin He; Tianyang Hu; Anju Puri; Xiaozhuo Zheng; Haiyun Dai; Shuliang Guo

doi:10.3390/jcm11226709

Blood Urea Nitrogen Is Associated with In-Hospital Mortality in Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis

J Clin Med. 2022 Nov 13;11(22):6709. doi: 10.3390/jcm11226709.

Authors

Mohan Giri¹, Lin He², Tianyang Hu³, Anju Puri¹, Xiaozhuo Zheng¹, Haiyun Dai¹, Shuliang Guo¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No 1 Youyi Road, Yuzhong, Chongqing 400016, China.
² Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing 408000, China.
³ Precision Medicine Center, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.

Abstract

Background: Elevated blood urea nitrogen (BUN) level is associated with a higher risk of mortality in various diseases; however, the association between BUN level and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to the intensive care unit (ICU) is not known. This study aimed to investigate the relationship between BUN level and in-hospital mortality in patients with AECOPD admitted to the ICU. Methods: In this retrospective cohort study, AECOPD patients were identified from the Medical Information Mart for Intensive Care (MIMIC-IV) database. Multivariate regression was used to elucidate the relationship between BUN level and in-hospital mortality, and propensity score matching (PSM) was used to adjust confounders. Receiver operating characteristics and Kaplan−Meier curves were used to evaluate the relationship between BUN level and in-hospital mortality. Results: Data from 1201 patients were analyzed. The all-cause in-hospital mortality was 13.7%. BUN levels were significantly higher in non-survivors compared to the survival group before (p < 0.001) and after (p = 0.005) PSM. Multivariate analysis indicated that elevated BUN levels were independently associated with increased risk of in-hospital mortality both before (p = 0.002) and after (p = 0.015) PSM. The optimal BUN cut-off value for in-hospital mortality in critical patients with AECOPD before (>23 mg/dL) and after (>22 mg/dL) PSM was comparable. Compared with the low BUN group, the hazard ratio (HR) of the high BUN group was 1.8987 (before PSM) and 1.7358 (after PSM). Conclusions: Higher BUN levels were significantly associated with an increased risk of in-hospital mortality in critically ill patients with AECOPD. As a widely available and rapidly measured biomarker, BUN may be useful in the risk stratification of critically ill AECOPD patients. The results need to be verified in prospective studies.

Keywords: acute exacerbation of chronic obstructive pulmonary disease; blood urea nitrogen; critical care; intensive care unit; mortality; propensity score matching.

Grants and funding

This study was supported by a 2020 Municipal Subsidy for Training Senior Medical Talents (project number 0202czzx2027 (YC006)) and a China Postdoctoral Research Grant (number P0465).