Highlights
- •Blood Urea Nitrogen to Creatinine Ratio (BCR) may contribute to risk stratification.
- •High and low BCR were associated with poor neurological outcomes.
- •The association between BCR and outcome was stronger in patients with cardiac aetiology.
Abstract
Background
We aimed to investigate the association between blood urea nitrogen to creatinine
ratio (BCR) and survival with favourable neurological outcomes in patients with out-of-hospital
cardiac arrest (OHCA).
Methods
This prospective, multicentre, observational study conducted in Osaka, Japan enrolled
consecutive OHCA patients transported to 16 participating institutions from 2012 through
2019. We included adult patients with non-traumatic OHCA who achieved a return of
spontaneous circulation and whose blood urea nitrogen and creatinine levels on hospital
arrival were available. Based on BCR values, they were divided into: ‘low BCR’ (BCR
<10), ‘normal BCR’ (10 ≤ BCR < 20), ‘high BCR’ (20 ≤ BCR < 30), and ‘very high BCR’
(BCR ≥ 30). We evaluated the association between BCR values and neurologically favourable
outcomes, defined as cerebral performance category score of 1 or 2 at one month after
OHCA.
Results
Among 4415 eligible patients, the ‘normal BCR’ group had the highest favourable neurological
outcome [19.4 % (461/2372)], followed by ‘high BCR’ [12.5 % (141/1127)], ‘low BCR’
[11.2 % (50/445)], and ‘very high BCR’ groups [6.6 % (31/471)]. In the multivariable
analysis, adjusted odds ratios for ‘low BCR’, ‘high BCR’, and ‘very high BCR’ compared
with ‘normal BCR’ for favourable neurological outcomes were 0.58 [95 % confidence
interval (CI 0.37–0.91)], 0.70 (95 % CI 0.49–0.99), and 0.40 (95 % CI 0.21–0.76),
respectively. Cubic spline analysis indicated that the association between BCR and
favourable neurological outcomes was non-linear (p for non-linearity = 0.003). In subgroup analysis, there was an interaction between
the aetiology of arrest and BCR in neurological outcome (p for interaction <0.001); favourable neurological outcome of cardiogenic OHCA patients
was lower when the BCR was higher or lower, but not in non-cardiogenic OHCA patients.
Conclusions
Both higher and lower BCR were associated with poor neurological outcomes compared
to normal BCR, especially in cardiogenic OHCA patients.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 23, 2022
Accepted:
November 6,
2022
Received in revised form:
October 31,
2022
Received:
September 10,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
