Description

Wu et al correlated blood urea nitrogen concentrations and mortality in patients with acute pancreatitis. The BUN can help to identify a patient who may benefit from aggressive management. The authors are from Brigham and Women’s Hospital, University Medical Center Utrecht, University of Pittsburgh, and the Johns Hopkins Hospital.


 

Patient selection: hospital admission for acute pancreatitis

 

Parameters:

(1) serum BUN on admission

(2) second BUN at about 24 hours after admission (18 to 30 hours)

 

change in BUN =

= (second BUN) – (admission BUN)

 

Parameter

Finding

Points

admission BUN

< 20 mg/dL

0

 

>= 20 mg/dL

1

change in BUN

< 0

0

 

>= 0

1

 


where: 

• The authors refer to a change >= 0 as a rise in the second value. This could also be referred as a failure to fall.

 

number of risk factors for mortality =

= SUM(points for the 2 measures)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 2

• The odds ratio for the first measure is 4.6 and for the second is 4.3.

 

The authors developed an algorithm for predicting mortality.

 

Admission BUN

Change in BUN

Mortality

< 20 mg/dL

< 2 mg/dL

0 to 1%

< 20 mg/dL

>= 2 mg/dL

7 to 15%

>= 20 mg/dL

< 5 mg/dL

0 to 3%

>= 20 mg/dL

>= 5 mg/dL

9 to 20%

 

Performance:

• The area under the ROC curve was 0.82 to 0.91.

• It is considered by the authors to be comparable to use of the APACHE II score.

 


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