| BackgroundsAcute heart failure(AHF),one of the most common diagnoses in modern medicine system,is a potentially life-threatening condition and a most common cause of hospital admissions in elderly patients.Mortality and readmission rates after hospitalization in AHF patients remain high despite advances in their treatment in recent years.The ratio of blood urea nitrogen to creatinine(BUN/Cr)is proposed as a good measure of neurohormonal activity and can be significantly elevated in patients with severe heart failure.The high BUN/Cr level is an independent predictor for poor prognosis in patients with heart failure and was associated with higher mortality even after adjusting for other prognostic factors including blood urea nitrogen(BUN)and creatinine(Cr).However,another study found that the BUN/Cr increased with age in normal subjects.Therefore,the predictive effect of BUN/Cr on long-term survival in elderly patients is also required further explore.Moreover,the high readmission rate of elderly patients with AHF is directly related to their quality of life,and the effect of BUN/Cr on the readmission rate of elderly AHF patients remains to be confirmed.ObjectiveThis study aims to evaluate the prognostic value of the ratio of blood urea nitrogen to creatinine(BUN/Cr)on all-cause mortality and readmission due to heart failure in elderly patients with AHF.MethodsWe selected elderly patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University due to acute heart failure from December 2019 to January 2021.patients with end-stage renal disease requiring regular dialysis therapy,active gastrointestinal bleeding,acute urinary tract obstruction,rupture of urinary bladder,malignant tumor,malnutrition,severe hepatic insufficiency and other diseases were excluded.A total of 271 patients were included.The receiver operating characteristic(ROC)curve showed that the cutoff value of BUN/Cr for predicting adverse prognosis in elderly AHF patients was 23.69.According to the BUN/Cr,the patients were divided into two groups:low □ level BUN/Cr group(BUN/Cr≤23.69,n=168)and high □ level BUN/Cr group(BUN/Cr>23.69,n=103).The primary end points were all-cause mortality and readmission due to heart failure.All patients were followed up by telephone for up to 1 year,and the occurrence of outcomes was recorded.ResultsCompared with low □ level BUN/Cr group,the patients in high □ level BUN/Cr group had a higher risk of all-cause mortality(9.5%vs.19.4%,P=0.020)and readmission due to heart failure(36.9%vs.66%,P<0.001).Kaplan-Meier survival analysis results illustrated that the all-cause mortality rate and readmission for heart failure rate of high □ level BUN/Cr group were higher than those of low □ level BUN/Cr group(Log Rank P=0.022;Log RankP<0.001).Variables showing statistical significance in the univariate analysis were incorporated into multivariate regression.After adjustment for age,gender,mean arterial pressure(MAP),left ventricular ejection fraction(LVEF),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),body mass index(BMI),sodium,potassium,hemoglobin and estimated glomerular filtration rate(eGFR),patients in high □ level BUN/Cr group had a higher risk of all-cause death and readmission for heart failure(HR=2.14,95%CI 1.08～4.25,P=0.030;HR=1.972,95%CI 1.38～2.83,P<0.001).Stratified analysis showed that,without hypertension,BUN/Cr had a more significant effect on all-cause mortality in elderly AHF patients younger than 75 years(HR=4.59,95%CI 1.79～11.74,P for interaction=0.009).ConclusionsThe ratio of blood urea nitrogen to creatinine(BUN/Cr)of elderly patients with AHF at admission is associated with the long-term prognosis.and the high BUN/Cr level is an independent predictor for all-cause mortality and readmission due to heart failure in elderly patients with AHF. |
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