The role of BUN/creatinine ratio in determining the severity of gastrointestinal bleeding and bleeding localization.

Northern clinics of Istanbul Pub Date : 2025-04-28 eCollection Date: 2025-01-01 DOI:10.14744/nci.2025.34366
Aslihan Calim
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Abstract

Objective: The aim of the study is to evaluate an established biomarker such as blood urea nitrogen (BUN)/Creatinine ratio in predicting upper gastrointestinal bleeding versus lower GI and stratify its severity. The aim of this study is to evaluate the diagnostic performance in clinical practice and predestination as a prognostic factor, including admission to an intensive care unit (ICU) or mortality rate for BUN/Creatinine ratio.

Methods: A total of 300 patients controlled in our hospital between January 2022 and January 2024 were evaluated retrospectively due to hospitalization by acute GI bleeding. Gastroscopy and/or colonoscopy were used to stratify patients into the upper or lower GI bleeding group. Data included demographic information, clinical presentation history and vital signs, comorbidity status, medication use, clinical outcomes and laboratory tests including hemoglobin, hematocrit, urea, creatinine levels and so on. The BUN/Creatinine ratio was determined and correlated with site as well as severity of bleeding. Statistical techniques, such as logistic regression and receiver operating characteristic (ROC) analysis, were used to assess the diagnostic performance of the ratio and to choose a cut-off value.

Results: Among the 300 patients, 215 (71.7% had upper GI bleeding, and 85 (28.3% had lower GI bleeding. Hematemesis and melena were significantly associated with upper GI bleeding, whereas hematochezia was more common in lower GI bleeding. Patients with upper GI bleeding had significantly higher BUN, urea, and BUN/Creatinine ratios, while hemoglobin and hematocrit levels were lower. The optimal BUN/Creatinine cut-off value of 23.3 demonstrated high sensitivity (89.3%) and specificity (94.1%) for distinguishing between upper and lower GI bleeding. Multivariate analysis revealed BUN/Creatinine ratio, hematochezia and endoscopic intervention as an independent predictor of bleeding location. Patients with BUN/Creatinine ratio >23.3 showed increased frequency of red blood cell transfusion, endoscopic intervention, and mortality.

Conclusion: The BUN/Creatinine ratio is a sensitive, noninvasive biomarker for distinguishing between upper and lower GI bleed and severity. Its introduction into clinical practice may enhance the decision process and patient care, especially in critical care contexts. Additional research is indicated to confirm these results and to define standardized cut-off values for wider use.

BUN/肌酐比值在判断消化道出血严重程度及出血定位中的作用。
目的:该研究的目的是评估一种既定的生物标志物,如血尿素氮(BUN)/肌酐比值,以预测上消化道出血与下消化道出血,并对其严重程度进行分层。本研究的目的是评估临床实践中的诊断性能和作为预后因素的宿命,包括BUN/肌酐比值的重症监护病房(ICU)入院或死亡率。方法:回顾性分析我院2022年1月~ 2024年1月收治的急性消化道出血住院患者300例。胃镜和/或结肠镜检查将患者分为上消化道出血组或下消化道出血组。资料包括人口统计资料、临床表现史和生命体征、合并症、用药情况、临床结果和血红蛋白、红细胞压积、尿素、肌酐水平等实验室检查。测定BUN/肌酐比值,并与出血部位及严重程度相关。统计技术,如逻辑回归和受试者工作特征(ROC)分析,被用来评估比率的诊断性能和选择一个截止值。结果:300例患者中,215例(71.7%)发生上消化道出血,85例(28.3%)发生下消化道出血。呕血和黑黑与上消化道出血显著相关,而便血在下消化道出血中更为常见。上消化道出血患者的BUN、尿素和BUN/肌酐比值明显较高,而血红蛋白和红细胞压积水平较低。最佳BUN/肌酐临界值为23.3,在区分上、下消化道出血方面具有较高的敏感性(89.3%)和特异性(94.1%)。多因素分析显示BUN/肌酐比值、便血和内镜干预是出血部位的独立预测因子。BUN/肌酐比值bbb23.3的患者红细胞输注、内镜干预和死亡率增加。结论:BUN/肌酐比值是区分上、下消化道出血及其严重程度的一种敏感、无创的生物标志物。将其引入临床实践可以提高决策过程和患者护理,特别是在重症监护环境中。建议进行进一步的研究,以证实这些结果,并确定标准化的临界值,以便更广泛地使用。
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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