Association between Blood Urea Nitrogen-to-creatinine Ratio and Three-Month Outcome in Patients with Acute Ischemic Stroke

Author(s): Linghui Deng, Changyi Wang, Shi Qiu, Haiyang Bian, Lu Wang, Yuxiao Li, Bo Wu*, Ming Liu*

Journal Name: Current Neurovascular Research

Volume 16 , Issue 2 , 2019

Become EABM
Become Reviewer
Call for Editor


Background: Hydration status significantly affects the clinical outcome of acute ischemic stroke (AIS) patients. Blood urea nitrogen-to-creatinine ratio (BUN/Cr) is a biomarker of hydration status. However, it is not known whether there is a relationship between BUN/Cr and three-month outcome as assessed by the modified Rankin Scale (mRS) score in AIS patients.

Methods: AIS patients admitted to West China Hospital from 2012 to 2016 were prospectively and consecutively enrolled and baseline data were collected. Poor clinical outcome was defined as three-month mRS > 2. Univariate and multivariate logistic regression analyses were performed to determine the relationship between BUN/Cr and three-month outcome. Confounding factors were identified by univariate analysis. Stratified logistic regression analysis was performed to identify effect modifiers.

Results: A total of 1738 patients were included in the study. BUN/Cr showed a positive correlation with the three-month outcome (OR 1.02, 95% CI 1.00-1.03, p=0.04). However, after adjusting for potential confounders, the correlation was no longer significant (p=0.95). An interaction between BUN/Cr and high-density lipoprotein (HDL) was discovered (p=0.03), with a significant correlation between BUN/Cr and three-month outcome in patients with higher HDL (OR 1.03, 95% CI 1.00-1.07, p=0.04).

Conclusion: Elevated BUN/Cr is associated with poor three-month outcome in AIS patients with high HDL levels.

Keywords: Acute Ischemic Stroke, blood urea nitrogen, creatinine, high-density lipoprotein, modified ranking scale (mRS), therapeutics, score.

Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: A report from the american heart association. Circulation 2018; 137(12): e67-e492.
Wang G, Zhang Z, Ayala C, Dunet DO, Fang J, George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. J Stroke Cerebrovasc Dis 2014; 23(5): 861-8.
Lin LC, Yang JT, Weng HH, Hsiao CT, Lai SL, Fann WC. Predictors of early clinical deterioration after acute ischemic stroke. Am J Emerg Med 2011; 29(6): 577-81.
Wu FF, Hung YC, Tsai YH, et al. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc Disord 2017; 17(1): 154.
Kim H, Lee K, Choi HA, Samuel S, Park JH, Jo KW. Elevated blood urea nitrogen/creatinine ratio is associated with venous thromboembolism in patients with acute ischemic stroke. J Korean Neurosurg Soc 2017; 60(6): 620-6.
Lin CJ, Yang JT, Huang YC, Tsai YH, Lee MH, Lee M, et al. Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke. Am J Emerg Med 2016; 34(12): 2414-8.
Schrock JW, Glasenapp M, Drogell K. Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clin Neurol Neurosurg 2012; 114(7): 881-4.
Kong FY, Tao WD, Hao ZL, Liu M. Predictors of one-year disability and death in Chinese hospitalized women after ischemic stroke. Cerebrovascular Ddiseases (Basel, Switzerland) 2010; 29(3): 255-62.
Tan G, Yuan R, Hao Z, et al. Liver function indicators performed better to eliminate cardioembolic stroke than to identify it from stroke subtypes. J Stroke Cerebrovasc Dis 2017; 26(1): 230-6.
Yuan R, Wang D, Liu M, et al. Long-term prognosis of spontaneous intracerebral hemorrhage on the Tibetan Plateau: A prospective cohort study at 2 hospitals. World Neurosurg 2016; 93: 6-10.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007; 335(7624): 806-8.
Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343(25): 1826-32.
Goldman L, Schafer AI. Goldman-Cecil Medicine In: Reference intervals and laboratory values Ronald JE, Eds; 25th ed Elsevier 2016; pp. 2712-20.
Mackey RH, Greenland P, Goff DC Jr, Lloyd-Jones D, Sibley CT, Mora S. High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol 2012; 60(6): 508-16.
Houston DK, Tooze JA, Neiberg RH, et al. 25-hydroxyvitamin D status and change in physical performance and strength in older adults: The health, aging, and body composition study. Am J Epidemiol 2012; 176(11): 1025-34.
Park SY, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann Intern Med 2017; 167(4): 228-35.
Bahouth MN, Gottesman RF, Szanton SL. Primary ‘dehydration’ and acute stroke: A systematic research review. J Neurol 2018; 265(10): 2167-81.
Hillis AE, Ulatowski JA, Barker PB, et al. A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis 2003; 16(3): 236-46.
Ginsberg MD. Expanding the concept of neuroprotection for acute ischemic stroke: The pivotal roles of reperfusion and the collateral circulation. Prog Neurobiol 2016; 145-146: 46-77.
Rodriguez GJ, Cordina SM, Vazquez G, et al. The hydration influence on the risk of stroke (THIRST) study. Neurocrit Care 2009; 10(2): 187-94.
Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Miller L, Silliman S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia 2013; 28(1): 69-76.
Deng QW, Wang H, Sun CZ, et al. Triglyceride to high-density lipoprotein cholesterol ratio predicts worse outcomes after acute ischaemic stroke. Eur J Neurol 2017; 24(2): 283-91.
Ryu WS, Schellingerhout D, Jeong SW, Nahrendorf M, Kim DE. association between serum lipid profiles and early neurological deterioration in acute ischemic stroke. J Stroke Cerebrovasc Dis 2016; 25(8): 2024-30.
Yeh PS, Yang CM, Lin SH, et al. Low levels of high-density lipoprotein cholesterol in patients with atherosclerotic stroke: A prospective cohort study. Atherosclerosis 2013; 228(2): 472-7.
Rodriguez-Sanz A, Fuentes B, Martinez-Sanchez P, et al. High-density lipoprotein: A novel marker for risk of in-hospital infection in acute ischemic stroke patients? Cerebrovasc Dis 2013; 35(3): 291-7.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 09 July, 2019
Page: [166 - 172]
Pages: 7
DOI: 10.2174/1567202616666190412123705
Price: $65

Article Metrics

PDF: 39