title: Elevated blood urea nitrogen-to-creatinine ratio increased the risk of hospitalization and all-cause death in patients with chronic heart failure.
abstract: OBJECTIVE
  To examine the relationship between blood urea nitrogen (BUN)-to-creatinine ratio and the prognosis of chronic heart failure (HF).
  
  
  METHODS
  We analyzed the data from the cohort of 243 adult patients with chronic HF followed at the HF clinic in a tertiary medical center between December 2003 and June 2006. Primary endpoints were the events of all-cause death and first hospitalization for HF.
  
  
  RESULTS
  During a median follow-up of 1.2 years, 72 events were recorded with an event rate of 25.7 events per 100 person-years. In multivariate-adjusted Cox regression models, elevated BUN-to-creatinine ratio was associated with a heightened risk of hospitalization and all-cause death [hazard ratio (HR), 1.24; 95% confidence interval (CI), 1.02-1.51]. The relationship remained after adjusting for glomerular filtration rate (GFR) (HR, 1.23; 95% CI, 1.01-1.51). There was a linear trend toward increasing risks of adverse outcomes across the tertiles of BUN-to-creatinine ratio (P = 0.02). The coexisting presence of the third tertile of BUN-to-creatinine ratio and GFR < 60 ml/min/1.73 m(2) tended to pose a synergistic risk for hospitalization and all-cause death (relative risk, 2.29), relative to those at the first and second tertiles who had GFR > or = 60 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  An elevated BUN-to-creatinine ratio, independent of GFR, confers an increased risk of hospitalization and all-cause death in patients with chronic HF.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. hungjulin@ntu.edu.tw
authors.forename: Hung-Ju
authors.initials: HJ
authors.lastname: Lin
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Chao
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
authors.forename: Yi-Lwun
authors.initials: YL
authors.lastname: Ho
authors.forename: Chii-Ming
authors.initials: CM
authors.lastname: Lee
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.forename: Ron-Bin
authors.initials: RB
authors.lastname: Hsu
authors.forename: Nai-Kuan
authors.initials: NK
authors.lastname: Chou
authors.forename: Shoei-Shen
authors.initials: SS
authors.lastname: Wang
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Chen
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000652:urine; D001806:Blood Urea Nitrogen; D002423:Cause of Death; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine