Elevated BUN Upon Admission as a Predictor of in-Hospital Mortality Among Patients with Acute Exacerbation of COPD: A Secondary Analysis of Multicenter Cohort Study

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Abstract

Background

High blood urea nitrogen (BUN) is observed in a subset of patients with acute exacerbation of COPD (AECOPD) and may be linked to clinical outcome, but findings from previous studies have been inconsistent.

Methods

We performed a retrospective analysis of patients prospectively enrolled in the MAGNET AECOPD Registry study (ChiCTR2100044625). Receiver operating characteristic (ROC) was used to determine the level of BUN that discriminated survivors and non-survivors. Univariate and multivariate Cox proportional hazards regression analyses were performed to assess the impact of BUN on adverse outcomes.

Results

Overall, 13,431 consecutive inpatients with AECOPD were included in this study, of whom 173 died, with the mortality of 1.29%. The non-survivors had higher levels of BUN compared with the survivors [9.5 (6.8–15.3) vs 5.6 (4.3–7.5) mmol/L, P < 0.001]. ROC curve analysis showed that the optimal cutoff of BUN level was 7.30 mmol/L for in-hospital mortality (AUC: 0.782; 95% CI: 0.748–0.816; P < 0.001). After multivariate analysis, BUN level ≥7.3 mmol/L was an independent risk factor for in-hospital mortality (HR = 2.099; 95% CI: 1.378–3.197, P = 0.001), also for invasive mechanical ventilation (HR = 1.540; 95% CI: 1.199–1.977, P = 0.001) and intensive care unit admission (HR = 1.344; 95% CI: 1.117–1.617, P = 0.002). Other independent prognostic factors for in-hospital mortality including age, renal dysfunction, heart failure, diastolic blood pressure, pulse rate, PaCO2 and D-dimer.

Conclusion

BUN is an independent risk factor for in-hospital mortality in inpatients with AECOPD and may be used to identify serious (or severe) patients and guide the management of AECOPD.

Clinical Trial Registration

MAGNET AECOPD; Chinese Clinical Trail Registry NO.: ChiCTR2100044625; Registered March 2021, URL: http://www.chictr.org.cn/showproj.aspx?proj=121626 .

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Most cited references 37

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Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.

W S Lim (2003)

In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups. Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort. 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age >/=65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin 7 mmol/l, Respiratory rate >/=30/min, low systolic( /=65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern. A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): copd

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date (Electronic): 13 July 2023

Publication date Collection: 2023

Volume: 18

Pages: 1445-1455

Affiliations

[1 ]Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University , Chengdu, Sichuan Province, People’s Republic of China

[2 ]State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University , Chengdu, People’s Republic of China

[3 ]West China School of Medicine, West China Hospital, Sichuan University , Chengdu, Sichuan Province, People’s Republic of China

[4 ]State Key Laboratory of Respiratory Disease, Guangzhou Medical University , Guangzhou, Guangdong Province, People’s Republic of China

[5 ]Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan , Leshan, Sichuan Province, People’s Republic of China

[6 ]Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang Province, People’s Republic of China

[7 ]Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province, People’s Republic of China

[8 ]Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province, People’s Republic of China

[9 ]Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City , Neijiang, Sichuan Province, People’s Republic of China

[10 ]Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University , Changsha, Hunan Province, People’s Republic of China

[11 ]Department of Emergency, First People’s Hospital of Jiujiang , Jiujiang, Jiangxi Province, People’s Republic of China

[12 ]Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University , Chengdu, Sichuan Province, People’s Republic of China

[13 ]Sichuan Cancer Hospital, University of Electronic Science and Technology of China , Chengdu, Sichuan Province, People’s Republic of China

Author notes

Correspondence: Haixia Zhou; Qun Yi, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University , Guo-Xue-Xiang 37#, Wuhou District, Chengdu, Sichuan Province, 610041, People’s Republic of China, Tel/Fax +86-28-85422571, Email zhouhaixia@wchscu.cn; yiqun925@126.com

[*]

These authors contributed equally to this work

Author information

Lige Peng http://orcid.org/0000-0003-3324-053X

Qun Yi http://orcid.org/0000-0002-3302-9139

Haixia Zhou http://orcid.org/0000-0002-5205-4487

Article

Publisher ID: 412106

DOI: 10.2147/COPD.S412106

PMC ID: 10351588

PubMed ID: 37465819

SO-VID: 7b8cfba6-a339-4e04-b566-3d2d58d9cc1f

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 11 March 2023

Date accepted : 09 July 2023

Page count

Figures: 3, Tables: 8, References: 37, Pages: 11

Funding

Funded by: the National Natural Science Foundation of China;

Funded by: the Sichuan Science and Technology Program;

Funded by: the National Key Research Program of China;

This study was supported by the National Natural Science Foundation of China (82170013), the Sichuan Science and Technology Program (2022YFS0262) and the National Key Research Program of China (2016YFC1304202).

Elevated BUN Upon Admission as a Predictor of in-Hospital Mortality Among Patients with Acute Exacerbation of COPD: A Secondary Analysis of Multicenter Cohort Study

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Background

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Results

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Clinical Trial Registration

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Most cited references 37

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary

Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study

Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.

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