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Kidney Week

ASN / Education & Meetings / Kidney Week /
Abstract: TH-PO0767

Dynamic Serum Urea Nitrogen (BUN)-to-Creatinine Ratio Trajectories and Outcomes of Patients with Cirrhosis in the Intensive Care Unit (ICU): A MIMIC-IV Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Zheng, Xingyue, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
  • Xu, Youjun, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
  • Wang, Lailiang, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
  • Luo, Qun, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
  • Zhou, Fangfang, Ningbo No 2 Hospital, Ningbo, Zhejiang, China
Background

BUN-to-creatinine ratio (BCR) helps distinguish prerenal from intrinsic kidney injury in cirrhotic ICU patients, but its dynamic trajectories and prognostic value remain unclear.

Methods

We included 2,713 cirrhotic ICU patients. Group-based trajectory modeling (GBTM) identified BCR trajectories. Multivariable Cox regression, ordered logistic regression, and Fine-Gray competing risk models assessed associations with in-hospital mortality and AKI severity.

Results

Three trajectories emerged: ascending (Group 1, 29.27%), slowly ascending (Group 2, 42.87%), and mildly descending (Group 3, 27.87%). Classification stability was high (ARI=0.932). Compared to Group 1, Group 2 (HR=1.30) and Group 3 (HR=1.92) had higher mortality (both P<0.01). Group 3 showed lower AKI severity (OR=0.54, P<0.001) but no reduction in stage 3 AKI risk after accounting for competing death (SHR=1.13, P=0.460). Group 2 had higher stage 3 AKI risk (SHR=1.22, P=0.032).

Conclusion

BCR trajectory independently predicts mortality. The descending trajectory's poor prognosis likely reflects liver failure, not renal protection. BCR trajectories aid early risk stratification.

Figure 1 Dynamic trajectories of BUN-to-creatinine ratio (BCR) during hospitalization in ICU patients with cirrhosis

Figure 2 Kaplan-Meier survival curves for ICU patients with cirrhosis stratified by BCR trajectory groups