Main Article Content
Blood urea nitrogen and creatinine levels are routine laboratory tests for evaluating renal function. Renal dysfunction has been related to worse prognosis of cardiovascular diseases. The purpose of this study was to determine the relationship between admission blood urea nitrogen and creatinine levels with in-hospital mortality in acute myocardial infarction patients.
A cross-sectional study was performed using secondary data of 80 acute myocardial infarction patients hospitalized in Intensive Cardiac Care Unit of dr. Wahidin Sudirohusodo Hospital, Makassar, from June 2010 to July 2011. Admission blood urea nitrogen and creatinine levels were analyzed with Mann Whitney and Chi-Square tests.
Mortality risk in the patients with blood urea nitrogen levels >50 mg/dL was 3.58 higher compared with those with blood urea nitrogen levels <50 mg/dL [OR=3.58; 95% confidence interval (CI) =1.27-10.11, p=0.013]. Mean admission creatinine levels in surviving and non- surviving patients were 0.99 ± 0.30 mg/dL and 1.70 ± 1.99 mg/dL, respectively (p=0.043). Mortality risk in patients with creatinine levels >1.1 mg/dL was 3.0-fold higher compared to patients with creatinine levels <1.1 mg/dL [OR=3.00; 95% confidence interval (CI) =1.13-7.92, p=0.024]. Multiple logistic regression showed blood urea nitrogen to be a better predictor of mortality than creatinine (OR= 3.583, p=0.016 vs OR 1.844, p=0.317).
Patients with high levels of blood urea nitrogen and creatinine had higher mortality risks than patients with normal levels. Blood urea nitrogen was a better predictor of mortality than creatinine.
Apple FS, Jaffe AS. Cardiovascular disease. In: Burtis CA, Ashwood ER, Bruns DE, editors. TIETZ fundamentals of clinical chemistry. 6th ed. Philadelphia: Saunders Elsevier;2008.p.614-30.
Lamb EJ, Price CP. Creatinine, urea and uric acid. In: Burtis CA, Ashwood ER, Bruns DE, editors. TIETZ fundamentals of clinical chemistry. 6th ed. Philadelphia: Saunders Elsevier;2008.p.363-72.
Delaney M, Price CP, Lamb EJ. Kidney function and disease. In: Burtis CA, Ashwood ER, Bruns DE, editors. TIETZ fundamentals of clinical chemistry. 6th ed. Philadelphia: Saunders Elsevier;2008.p.631-54.
Carter, CE, Gansevoort RT, Scheven L, Heerspink HJL, Shlipak MG, de Jong P, et al. Influence of urine creatinine on relationship between the albumin-to-creatinine ratio and cardiovascular events. Clin J Am Soc Nephrol 2012;7:595-603. doi:10.2215/CJN.09300911.
French WJ, Wright RS. Renal insufficiency and worsened prognosis with STEMI: a call for action. J Am Coll Cardiol 2003;42:1544-6.
Cakar MA, Gunduz H, Vatan MB, Kocayigit I, Akdemir R. The effect of admission creatinine levels on one-year mortality in acute myocardial infarction. Scientific World Journal 2012. doi:10.1100/2012/186495.
Kirtane AJ, Leder DM, Waikar SS, Chertow GM, Ray KK, Pinto DS, et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol 2005;45:1781-6.doi:10.1016/j.jacc.2005.02.068.
Sorensen CR, Brendorp B, Rask-Madsen C, Kober L, Kjiller E, Torp-Pedersen C. The prognostic importance of creatinine clearance after acute myocardial infarction. Eur Heart J 2002;23:948-2. doi:10.1053/euhj.2001.2989.
Jose P, Skali H, Anavekar N, Tomson C, Krumholz HM, Rouleau JL, et al. Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction. J Am Soc Nephrol 2006;17:2886-91.
Smith GL, Shlipak MG, Havranek EP, Foofy JM, Masoudi FA, Rathore SS, et al. Serum urea nitrogen, creatinine, and estimators of renal function: mortality in older patients with cardiovascular disease. Arch Intern Med 2006; 166:1134-42.
Lazaros G, Tsiachris D, Tousoulis D, Patialiakas A, Dimitriadis K, Roussos D, et al. In-hospital worsening renal function is an independent predictor of one-year mortality in patients with acute myocardial infarction. Int J Cardiol 2012; 155:97-101.
Amin AP, Spertus JA, Reid KJ, Lan X, Buchanan DM, Decker C, et al. The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality. Am Heart J 2010;160:1065-71.
Aronson D, Hammerman H, Beyar R, Yalonetsky S, Kapeliovich M Markiewich W, et al. Serum blood urea nitrogen and long term mortality in acute ST-elevation myocardial infarction. Int J Cardiol 2008;127:380-5.
Zhang B, Gao C, Hou Q, Yin J, Xie L, Pu S, et al. Different independent susceptibility markers for first-ever cerebral infarction and myocardial infarction in young patients. J Neurol 2012; 259:1420–5.DOI 10.1007/s00415-011-6368-3.
Ostfeld R, Spinelli M, Mookherjee D, Holtzman D, Shoyeb A, Schaefer M, et al. The association of blood urea nitrogen levels and coronary artery disease. EJBM 2010;25:3-7.
Gibson CM, Pinto DS, Murphy SA, Morrow DA, Hobbach HP, Wiviott SD, et al. Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol 2003; 42:1535-43. doi:10.1016/S0735-1097(03)01067 -2.
Sachdeva S, Singh NP, Saha R. Impact of renal dysfunction on the outcome of acute myocardial infarction. JIACM 2010;11:277-81.