Journal of Cardiac Failure
Volume 13, Issue 5 , Pages 360-364, June 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

  • Gerasimos Filippatos, MD

      Affiliations

    • From the Department of Cardiology, Athens University, Athens, Greece
    • ,
  • Joseph Rossi, MD

      Affiliations

    • Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • ,
  • Donald M. Lloyd-Jones, MD, ScM

      Affiliations

    • Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • ,
  • Wendy Gattis Stough, PharmD

      Affiliations

    • Division of Cardiology, Duke University Medical Center, Durham, North Carolina
    • Campbell University School of Pharmacy Department of Clinical Research, Research Triangle Park, North Carolina
    • ,
  • John Ouyang, PhD

      Affiliations

    • Otsuka Maryland Research Institute, Rockville, Maryland
    • ,
  • David D. Shin

      Affiliations

    • Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • ,
  • Christopher O'Connor, MD

      Affiliations

    • Division of Cardiology, Duke University Medical Center, Durham, North Carolina
    • ,
  • Kirkwood F. Adams, MD

      Affiliations

    • Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
    • ,
  • Cesare Orlandi, MD

      Affiliations

    • Otsuka Maryland Research Institute, Rockville, Maryland
    • ,
  • Mihai Gheorghiade, MD

      Affiliations

    • Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • Corresponding Author InformationReprint requests: Mihai Gheorghiade, MD, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Galter 10-240, 201 E Huron Street, Chicago, IL 60611.

Received 30 June 2006; received in revised form 12 January 2007; accepted 21 February 2007.

Athens, Greece; Chicago, Illinois; Durham, North Carolina; Research Triangle Park, North Carolina; Rockville, Maryland; Chapel Hill, North Carolina

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.

Key Words: Heart failure, blood urea nitrogen, mortality, morbidity, prognosis

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 The ACTIV in CHF trial and this analysis were funded by Otsuka Maryland Research Institute, Rockville, Maryland.

PII: S1071-9164(07)00051-6

doi:10.1016/j.cardfail.2007.02.005

Journal of Cardiac Failure
Volume 13, Issue 5 , Pages 360-364, June 2007

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