Search

Abstract Background Patients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis. Methods This retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss. Results Of the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68–0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR. Conclusion The results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss.

Abstract Whereas urinary creatinine excretion (UCE) is an established marker of muscle mass, both in critically ill and non-critically ill patients, analysis of urinary urea excretion (UUE) may allow estimation of proteolysis that is associated with critical illness. We evaluated the time courses of plasma urea and creatinine as well UUE and UCE in critically ill patients with a prolonged ICU stay. Our goal was to evaluate changes in plasma urea and creatinine in conjunction with their urinary excretion, to get a better understanding of urea handling in ICU patients. From 2002 to 2021, plasma urea and creatinine, UUE and UCE were determined in routinely obtained 24 h urine samples between ICU admission and day 30, in adult patients with an ICU-stay ≥ 28d. Urea-to-creatinine ratios in plasma and urine were calculated. Patients with stage 3 acute kidney injury (AKI) were excluded. Analyses were performed separately for females and males and for patients with and without acute renal failure to account for respectively differences in muscle mass and impaired renal function. Of 47,120 patients, who were admitted to the ICU between 2002 and 2021, 638 patients met the inclusion criteria. During the first 10 days mean ± SD plasma urea increased from 9.7 ± 6.0 mmol/L at ICU admission to 12.4 ± 7.9 mmol/L (P

Abstract Purpose Acute decompensated heart failure (ADHF) patients with a poor renal function have a worse prognosis. The urea-to-creatinine ratio (UCR) may be a valuable tool for assessing kidney function and stratifying patients with ADHF. We evaluated the value of an admission and follow-up UCR in predicting AKI, 28-day mortality, and rehospitalization in patients with ADHF. Methods This prospective research comprised sixty patients with ADHF. Based on the mean admission UCR, patients are classified into two groups: the high UCR group (UCR ≥ 42.33) and the low UCR group (UCR 34.85 (p

Abstract Background Recent research has shown that the blood urea/creatinine ratio (BUN/Cr) rather than BUN or Cr alone can predict the prognosis of individuals with acute heart failure (AHF). The objective of this study was to estimate the urea-to creatinine serum ratio (BUN/Cr) in patients with acute decompensated heart failure (ADHF) and correlate the results with patient outcome, length of hospitalization, and mortality. Results Sixty ADHF patients were included and categorized into four groups; Group I: non-AKI with low BUN/Cr (n = 25); Group II: non-AKI with high BUN/Cr (n = 5); Group III: AKI with low BUN/Cr (n = 14); Group IV: AKI with high BUN/Cr (n = 16). Regarding urea and BUN levels, the first reading showed a considerable rise in urea and BUN levels in groups III and IV compared to group 1 and in group IV compared to groups I and III. Similar results were recorded in the second and third readings. Regarding the BUN/Cr ratio, the three readings revealed a significant elevation in group IV compared to groups I and II and in group IV compared to group III. Mortality was significantly higher in group IV compared to group I. Additionally, MACE was significantly more frequent in group IV compared to groups I and III. Multivariable logistic regression analysis revealed that hypertension, creatinine, and BUN were independent predictors of AKI. Conclusions BUN/Cr may predict prognosis in AHF patients since AHF with an elevated BUN/Cr is associated with a higher death rate.

Hyponatremia is associated with adverse outcomes in hospitalized patients. An elevated value of the serum urea-to-creatinine ratio (UCR) has been proposed as a proxy of hypovolemia. The aim of this study was to investigate the relationship between the UCR and in-hospital death in patients hospitalized with COVID-19 and hyponatremia. We studied 258 patients admitted for COVID-19 between January 2020 and May 2021 with serum sodium at < 135 mmol/L. The primary end-point was all-cause mortality. A 5-unit increase in the serum UCR during hospital stays was associated with an 8% increase in the hazard of all-cause death (HR = 1.08, 95% CI: 1.03–1.14, p = 0.001) after adjusting for potential confounders. In patients with a UCR > 40 at baseline, a > 10 mmol/L increase in serum sodium values within the first week of hospitalization was associated with higher odds of in-hospital death (OR = 2.93, 95% CI: 1.03–8.36, p = 0.044) compared to patients who experienced a < 10 mmol/L change. This was not observed in patients with a UCR < 40. Hypovolemia developing during hospital stays in COVID-19 patients with hyponatremia detected at hospital admission bears an adverse prognostic impact. Moreover, in hypovolemic patients, a > 10 mmol/L increase in serum sodium within the first week of hospital stays may further worsen the in-hospital prognosis.

Background: Timely assessment of COVID-19 severity is crucial for the rapid provision of appropriate treatments. Definitive criteria for the early identification of severe COVID-19 cases that require intensive care unit admission are lacking.Methods: This was a single-center, retrospective case-control study of 95 consecutive adults admitted to the intensive care unit (cases) or a medical ward (controls) for laboratory-confirmed COVID-19. Clinical data were collected and changes in laboratory test results were calculated between presentation at the emergency department and admission. Univariate and multivariable logistic regression was performed to calculate odds ratios for intensive care unit admission according to changes in laboratory variables.Results: Of the 95 adults with COVID-19, 25 were admitted to intensive care and 70 to a medical ward after a median 6 h stay in the emergency department. During this interval, neutrophil counts increased in cases and decreased in controls (median, 934 vs. −295 × 106/L; P = 0.006), while lymphocyte counts decreased in cases and increased in controls (median, −184 vs. 109 × 106/L; P < 0.001). In cases, the neutrophil-to-lymphocyte ratio increased 6-fold and the urea-to-creatinine ratio increased 20-fold during the emergency department stay, but these ratios did not change in controls (P < 0.001 for both comparisons). By multivariable logistic regression, short-term increases in the neutrophil-to-lymphocyte ratio (OR = 1.43; 95% CI, 1.16–1.76) and urea-to-creatinine ratio (OR = 1.72; 95% CI, 1.20–2.66) were independent predictors of intensive care unit admission.Conclusion: Short-time changes in neutrophil-to-lymphocyte ratio and urea-to-creatinine ratio emerged as stand-alone parameters able to identify patients with aggressive disease at an early stage.