Blood Urea Nitrogen as a Predictor of In-Hospital Mortality in Acute Coronary Syndrome Patients

Trisulo Wasyanto, Annisa Tridamayanti


Background: Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality worldwide. Thus, it is important to effectively diagnose and determine prognosis and mortality risk. While criteria such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) score are clinically used to work out the prognosis of patients with ACS, the examination of Blood Urea Nitrogen (BUN) and creatinine alongside in predicting outcome may prove favorable as well. This study aimed to determine the efficacy of BUN and creatinine in mortality risk assessment of patients with ACS and to find which one is better.

Subjects and Method: This was an analytical study with a cohort retrospective design included 1463 ACS patients in Dr. Moewardi hospital from January 2014 to July 2018. The relationship between admission BUN, creatinine level, and in-hospital mortality was analyzed with chi-square and logistic regression. Receiver Operating Characteristic (ROC) curve to determine which one better as a predictor of in-hospital mortality.

Results: The mean age of patients was 60 years old (mean= 60.08; SD= 11.04), which 72.9% were men. From all sample, 232 (15.9%) patients were died. In binary log regression models, elevated BUN (>50 mg/dL) at admission was an independent predictor of in-hospital mortality (OR= 4.01; 95% CI= 1.0 to 7.0; p= 0.001). Similar results were obtained for elevated creatinine (>1.3 mg/dL) at admission (OR= 3.6; 95% CI= 2.2 to 5.8; p= 0.031). ROC curves showed that area under the curve (AUC) of BUN (0.87) was higher than AUC of creatinine (0.61).

Conclusion: Elevated BUN and creatinine are independent predictors of in-hospital mortality in ACS patients. A high-level of BUN at admission is a more accurate predictor of in-hospital mortality than creatinine.

Keywords: blood urea nitrogen, creatinine, acute coronary syndrome

Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email:

Indonesian Journal of Medicine (2019), 4(3): 241-251

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