Association Between Blood Urea Nitrogen (Bun) to Creatinine Ratio and Outcome in Patients with Upper Gastrointestinal Bleed at a Tertiary Care Hospital in Chennai

Abstract

INTRODUCTION: Upper Gastrointestinal bleeding (UGIB) is one of the most common gastrointestinal presentation in Emergency Department. Several risk factors for UGI bleed have been identified to assist physicians for managing and predicting treatment outcomes. Some parameters such as Age, Albumin, level of consciousness, Heart rate and Systolic Blood Pressure and INR can be used to predict risk of mortality prior to Endoscopy. Early identification of high risk patients and urgent interventions like use of medications, blood transfusions, urgent endoscopic therapy improves outcomes. AIM OF THE STUDY: To determine if Blood Urea Nitrogen to creatinine ratio is associated with short term outcomes in patients admitted with Upper GI bleed. OBJECTIVE OF THE STUDY: Is Blood Urea Nitrogen to Creatinine ratio associated with short term outcomes in patients admitted with upper GI bleed. MATERIALS AND METHODS: using pretested proforma, patient details, history and clinical findings and investigations were documented. Descriptive study was conducted for a duration of 6 months from approval of study. RFT repeated at 24 hrs. BUN calculated from blood urea by dividing by a factor of 2.14. The BUN/Cr ratio was then calculated. The patient were followed up during the entire hospital stay. The intervention received by the patient, the endoscopic findings, and their clinical course in the hospital were noted. RESULTS: In our study patients, 53 (55.2%) were observed with less than 30 BUN/CR ratios whereas 43 (44.8%) patients were reported with a BUN/CR ratio of more than 30. In our study of all 50 patients with a BUN/CR ratio of more than 30, the majority of patients 31 (62%) were reported with mortality. Whereas of 46 patients having a BUN/CR ratio less than 30, only 7 (15.2%) patients were found with mortality. In our study 57 (59.4%) required ICU care and 39 (40.6%) patients recorded no ICU care requirement. When ICU care was correlated with the BUN/CR ratio it was found that of all 57 patients requiring ICU care 38 (88.4%) patients were recorded with a BUN/CR ratio of more than 30. Whereas in patients with no requirement of ICU care majority 34 (64.2%) reported with BUN/CR ratio of less than 30. CONCLUSION: In our study, a BUN/Cr ratio of >27.5 was identified as an independent risk factor for mortality and upper GI bleeding and may be useful for pre-endoscopic evaluation