Clinical implications of persistently increased blood urea nitrogen/serum creatinine ratio (PI-BUN/Cr) in severe COVID-19 patients
Por:
Aparicio, GC, Plata, RF, Iglesias, AH, Briseño, DM, Granado, RCD, Lopez, MC, Pérez, JV, Vásquez, NA, Cruz, RV, Silva, GH, Ruiz, V, Camarena, A, Lara, CS, Suck, MT, Ambriz, IMD, Toledo, OO, Serrano, VA, Chaparro, YA, Flores-Soto, E, Espíndola, LMT, Aquino-Gálvez, A, Topete, VHA
Publicada:
25 oct 2024
Resumen:
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.
Filiaciones:
Inst Nacl Enfermedades Respiratorias, Unidad enfermedades Intersticio Pulmonar Reumatol, Calzada Tlalpan 4502, Mexico City 14080, Mexico
Inst Nacl Enfermedades Respiratorias Ismael Cosio, Unidad Epidemiol Hosp & Infectol, Calzada Tlalpan 4502,Col Sect16, Mexico City 14080, Mexico
Univ Mayor San Simon, Hosp Obrero CNS 2, IIBISMED CUMETROP, Div Nefrol,Cochabamba Bolivia, Cochabamba, Bolivia
Univ Mayor San Simon, Hosp Obrero CNS 2, Fac Med, IIBISMED, Cochabamba, Bolivia
Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Lab Biol Mol Enfermedades Emergentes & EPOC, Calzada Tlalpan 4502, Mexico City 14080, Mexico
Inst Nacl Enfermedades Resp Ismael Cosio Villegas, EPOC, Calzada Tlalpan 4502, Mexico City 14080, Mexico
Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Dept Invest Biomed Mol Invest Translac, Calzada Tlalpan 4502, Mexico City 14080, Mexico
Inst Nacl Med Gen, Lab Gen Metab Oseo, Perifer 4809, Mexico City 14610, Mexico
Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Lab Biol Mol Enfermedades Emergentes & EPOC, Calzada Tlalpan 4502, Mexico City, Mexico
Inst Politecn Nacl, Escuela Super Med, Secc Estudios Posgrad & Invest, Plan San Luis & Diaz MirOn S-N, Mexico City 11340, Mexico
Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Lab Inmunobiol & Genet, Calzada Tlalpan 450, Mexico City, Mexico
Inst Nacl Neurol & Neurocirugia Manuel Velasco Su, Lab Neuropatol Expt, Insurgentes 3877, Mexico City 14269, DF, Mexico
Inst Nacl Neurol & Neurocirug, Insurgentes 3877, Mexico CIty, Mexico
Univ Nacl Autonoma Mexico, Fac Estudios Super Iztacala, Ave Barrios 1,Tlalnepantla Baz, Mexico City 54090, Mex, Mexico
Univ Nacl Autonoma Mexico, Fac Ciencias, Mexico City 04510, Mexico
Inst Nacl Pediat, Lab Farmacol, Insurgentes 3700, Mexico City 04530, Mexico
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