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<p>This retrospective cohort study examined the association between admission blood urea nitrogen (BUN) levels and mortality in critically ill acute ischemic stroke (AIS) patients from the MIMIC-IV database. Patients were stratified into quartiles based on admission BUN (Q1: ≤ 14&#xa0;mg/dL; Q2:14 &lt; BUN ≤ 19&#xa0;mg/dL; Q3:19 &lt; BUN ≤ 27&#xa0;mg/dL; Q4:&gt;27&#xa0;mg/dL). Multivariable Cox regression, adjusted for demographics, comorbidities, and labs, showed elevated BUN was independently associated with higher 30-day (HR = 1.017, 95% CI: 1.010–1.025), 90-day (HR = 1.014, 1.007–1.021), and 180-day mortality (HR = 1.011, 1.004–1.018). The critically ill AIS patients in the top BUN quartile (&gt; 27&#xa0;mg/dL) had a nearly 70% higher 30-day, 45% higher 90-day, and 36% higher 180-day mortality risk than those in the bottom quartile, even after full adjustment. Restricted cubic spline analysis demonstrated a linear dose-response relationship between BUN and mortality. Subgroup analysis showed a significant interaction between BUN and CKD: elevated BUN predicted mortality in non-CKD patients but had limited prognostic value in CKD patients. Notably, BUN elevation correlated more strongly with mortality in non-CKD patients. These findings suggest BUN may be an independent predictor useful for risk stratification in critically ill AIS populations, emphasizing its prognostic utility in non-CKD individuals. Further prospective studies are warranted to validate clinical applications and explore underlying mechanisms linking BUN to adverse outcomes.</p>

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Association between blood urea nitrogen levels and mortality in critical acute ischemic stroke patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月27日

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  • Liqun Hao,
  • Xuezhi Chen,
  • Lin Zhu,
  • Fei Li,
  • Yong Yu,
  • Mingkun Li,
  • Zhenhao Chen,
  • Yankui Guo

摘要

This retrospective cohort study examined the association between admission blood urea nitrogen (BUN) levels and mortality in critically ill acute ischemic stroke (AIS) patients from the MIMIC-IV database. Patients were stratified into quartiles based on admission BUN (Q1: ≤ 14 mg/dL; Q2:14 < BUN ≤ 19 mg/dL; Q3:19 < BUN ≤ 27 mg/dL; Q4:>27 mg/dL). Multivariable Cox regression, adjusted for demographics, comorbidities, and labs, showed elevated BUN was independently associated with higher 30-day (HR = 1.017, 95% CI: 1.010–1.025), 90-day (HR = 1.014, 1.007–1.021), and 180-day mortality (HR = 1.011, 1.004–1.018). The critically ill AIS patients in the top BUN quartile (> 27 mg/dL) had a nearly 70% higher 30-day, 45% higher 90-day, and 36% higher 180-day mortality risk than those in the bottom quartile, even after full adjustment. Restricted cubic spline analysis demonstrated a linear dose-response relationship between BUN and mortality. Subgroup analysis showed a significant interaction between BUN and CKD: elevated BUN predicted mortality in non-CKD patients but had limited prognostic value in CKD patients. Notably, BUN elevation correlated more strongly with mortality in non-CKD patients. These findings suggest BUN may be an independent predictor useful for risk stratification in critically ill AIS populations, emphasizing its prognostic utility in non-CKD individuals. Further prospective studies are warranted to validate clinical applications and explore underlying mechanisms linking BUN to adverse outcomes.