Urea-to-creatinine ratio as a biomarker for clinical outcome and response to nutritional support in non-critically ill patients: A secondary analysis of a randomized controlled trial

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-21 DOI:10.1016/j.clnesp.2025.03.042

Julian Diethelm , Carla Wunderle , Arthur R.H. van Zanten , Pascal Tribolet , Zeno Stanga , Beat Mueller , Philipp Schuetz

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引用次数: 0

Abstract

Background

Assessing a patient's catabolism in clinical practice is challenging but could help guide nutritional interventions. The urea-to-creatinine ratio (UCR) reflects muscle breakdown and protein metabolism and has been associated with risk for overfeeding and adverse outcomes in the critical care setting. We validated this concept in a well-characterized population of medical ward patients from a previous nutritional trial.

Methods

This secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT) examined baseline UCR and changes during follow-up in medical inpatients at risk for malnutrition. A catabolic state was defined as a high baseline UCR or an increase in UCR over 7 days. The primary endpoint was mortality at 30 days.

Results

We included 1595 of 2028 EFFORT patients with baseline UCR measurements and 870 who also had UCR measurements on day 7. A high baseline UCR, as well as an increase in UCR over 7 days, were associated with increased mortality (adjusted HR for 30-day mortality 2.05 (1.47–2.87) p < 0.001 and 2.02 (1.34–3.06) p = 0.001). There was no difference in treatment response when stratifying patients based on baseline or follow-up UCR.

Conclusion

Assessment of catabolism through UCR measurement at baseline and changes during follow-up was associated with increased mortality and adverse outcomes in medical inpatients at nutritional risk. However, this stratification was not associated with response to nutritional therapy in our sample. Further studies into the dynamic changes in UCR are needed to better understand the clinical implications for medical ward patients.

Clinical Trial Registration

Clinicaltrials.gov as NCT02517476 (registered 7 August 2015)

查看原文本刊更多论文

尿素与肌酐比值作为非危重患者临床结局和对营养支持反应的生物标志物：一项随机对照试验的二次分析

背景：在临床实践中评估患者的分解代谢是具有挑战性的，但可以帮助指导营养干预。尿素-肌酐比（UCR）反映了肌肉分解和蛋白质代谢，并与重症监护环境中过度喂养的风险和不良后果相关。我们在之前的营养试验中对一组特征良好的病房患者进行了验证。方法：这项关于早期营养支持对营养不良住院患者虚弱、功能结局和康复影响的二级分析试验（EFFORT）检查了有营养不良风险的住院患者的基线UCR和随访期间的变化。分解代谢状态定义为高基线UCR或超过7天的UCR增加。主要终点为30天死亡率。结果：我们纳入了2028例具有基线UCR测量的EFFORT患者中的1595例和870例在第7天也有UCR测量的患者。高基线UCR以及超过7天的UCR增加与死亡率增加相关（调整后的30天死亡率HR为2.05(1.47至2.87)）。结论：通过基线UCR测量和随访期间的变化来评估分解代谢与营养风险住院患者死亡率增加和不良结局相关。然而，在我们的样本中，这种分层与对营养治疗的反应无关。需要进一步研究UCR的动态变化，以更好地了解对内科病房患者的临床意义。临床试验注册：Clinicaltrials.gov: NCT02517476（注册于2015年8月7日）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.