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Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study.
J Card Fail. 2007 Jun; 13(5):360-4.JC

Abstract

BACKGROUND

Hospitalization for acute decompensated heart failure (ADHF) is associated with a high postdischarge mortality and readmission rate. The association between baseline blood urea nitrogen (BUN) and clinical outcomes in patients admitted for ADHF was evaluated in a post-hoc analysis of the ACTIV in CHF trial.

METHODS AND RESULTS

Patients were categorized into quartiles according to baseline BUN. Cox proportional hazards regression was used to test the association between BUN, mortality, and death or readmission within 60 days. Patients in the highest quartile (>40 mg/dL) had the highest 60-day mortality (14.3%, 9.3%, 4.0%, 0%, respectively; P < .001) and the highest rate of death or heart failure hospitalization (30.0%, 21.3% 18.4%, 8.6%; P < .001). After adjustment for covariates, BUN was a statistically significant predictor of both mortality and the composite endpoint of death or heart failure hospitalization at 60 days after hospital discharge. Serum creatinine and estimated creatinine clearance did not predict mortality after covariate adjustment.

CONCLUSIONS

Higher baseline BUN is a powerful predictor of increased postdischarge mortality in patients hospitalized for heart failure, even in the absence of severe renal failure. Even mild to moderate elevations in baseline BUN were predictive. BUN remains an easily accessible risk stratification tool that physicians should closely monitor in the hospital setting.

Authors+Show Affiliations

Department of Cardiology, Athens University, Athens, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17602982

Citation

Filippatos, Gerasimos, et al. "Prognostic Value of Blood Urea Nitrogen in Patients Hospitalized With Worsening Heart Failure: Insights From the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) Study." Journal of Cardiac Failure, vol. 13, no. 5, 2007, pp. 360-4.
Filippatos G, Rossi J, Lloyd-Jones DM, et al. Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study. J Card Fail. 2007;13(5):360-4.
Filippatos, G., Rossi, J., Lloyd-Jones, D. M., Stough, W. G., Ouyang, J., Shin, D. D., O'connor, C., Adams, K. F., Orlandi, C., & Gheorghiade, M. (2007). Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study. Journal of Cardiac Failure, 13(5), 360-4.
Filippatos G, et al. Prognostic Value of Blood Urea Nitrogen in Patients Hospitalized With Worsening Heart Failure: Insights From the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) Study. J Card Fail. 2007;13(5):360-4. PubMed PMID: 17602982.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study. AU - Filippatos,Gerasimos, AU - Rossi,Joseph, AU - Lloyd-Jones,Donald M, AU - Stough,Wendy Gattis, AU - Ouyang,John, AU - Shin,David D, AU - O'connor,Christopher, AU - Adams,Kirkwood F, AU - Orlandi,Cesare, AU - Gheorghiade,Mihai, PY - 2006/06/30/received PY - 2007/01/12/revised PY - 2007/02/21/accepted PY - 2007/7/3/pubmed PY - 2007/7/20/medline PY - 2007/7/3/entrez SP - 360 EP - 4 JF - Journal of cardiac failure JO - J Card Fail VL - 13 IS - 5 N2 - BACKGROUND: Hospitalization for acute decompensated heart failure (ADHF) is associated with a high postdischarge mortality and readmission rate. The association between baseline blood urea nitrogen (BUN) and clinical outcomes in patients admitted for ADHF was evaluated in a post-hoc analysis of the ACTIV in CHF trial. METHODS AND RESULTS: Patients were categorized into quartiles according to baseline BUN. Cox proportional hazards regression was used to test the association between BUN, mortality, and death or readmission within 60 days. Patients in the highest quartile (>40 mg/dL) had the highest 60-day mortality (14.3%, 9.3%, 4.0%, 0%, respectively; P < .001) and the highest rate of death or heart failure hospitalization (30.0%, 21.3% 18.4%, 8.6%; P < .001). After adjustment for covariates, BUN was a statistically significant predictor of both mortality and the composite endpoint of death or heart failure hospitalization at 60 days after hospital discharge. Serum creatinine and estimated creatinine clearance did not predict mortality after covariate adjustment. CONCLUSIONS: Higher baseline BUN is a powerful predictor of increased postdischarge mortality in patients hospitalized for heart failure, even in the absence of severe renal failure. Even mild to moderate elevations in baseline BUN were predictive. BUN remains an easily accessible risk stratification tool that physicians should closely monitor in the hospital setting. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/17602982/Prognostic_value_of_blood_urea_nitrogen_in_patients_hospitalized_with_worsening_heart_failure:_insights_from_the_Acute_and_Chronic_Therapeutic_Impact_of_a_Vasopressin_Antagonist_in_Chronic_Heart_Failure__ACTIV_in_CHF__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1071-9164(07)00051-6 DB - PRIME DP - Unbound Medicine ER -