Correlation between C-Reactive Protein Level and Blood Urea Nitrogen-Creatinine Ratio in COVID-19 Patients

Coronavirus Disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2).C-Reactive Protein (CRP) is an inflammation marker that increases significantly in COVID-19 patients. SARS-CoV-2 can affectkidney function and increase the Blood Urea Nitrogen (BUN)-creatinine ratio. The previous study showed that CRP andBUN-creatinine ratios could be used as predictors of the severity and survival of COVID-19 patients. This study aimed todetermine the correlation between CRP levels and the BUN-creatinine ratio in COVID-19 patients. A retrospectivecross-sectional study was conducted on 34 COVID-19 patients who were diagnosed by PCR test at Dr. Kariadi Hospital,Semarang from March to September 2020. The Spearman correlation test was used for statistical analysis. The median CRPvalue was 4.59 (0.36-27.48) mg/L and BUN-creatinine ratio was 15.06 (5.79-37.04), while the correlation between CRP andBUN-creatinine ratio showed p=0.003 and r=0.502. There was a moderate positive correlation between CRP level andBUN-creatinine ratio. C-reactive protein plays a role in the infiltration process of inflammatory cells and increases adhesionmolecules, which can directly or indirectly damage kidney function. SARS-CoV-2 can enter the kidney directly through theACE-2 receptor and activate the renin-angiotensin-aldosterone system, which will increase water and sodium absorption inthe renal tubules, passive reabsorption of BUN, and creatinine filtration in the glomerulus resulting in increasedBUN-creatinine ratio.

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ABC2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores

10.1101/2021.02.01.21250306 ◽

2021 ◽

Author(s):

Milena S. Marcolino ◽

Magda C. Pires ◽

Lucas Emanuel F. Ramos ◽

Rafael T. Silva ◽

Luana M. Oliveira ◽

...

Keyword(s):

Heart Rate ◽

Hospital Mortality ◽

Blood Urea Nitrogen ◽

Risk Score ◽

Mortality Risk ◽

Scoring System ◽

List Type ◽

C Reactive Protein ◽

Urea Nitrogen ◽

Reactive Protein

AbstractObjectiveTo develop and validate a rapid scoring system at hospital admission for predicting in-hospital mortality in patients hospitalized with coronavirus disease 19 (COVID-19), and to compare this score with other existing ones.DesignCohort studySettingThe Brazilian COVID-19 Registry has been conducted in 36 Brazilian hospitals in 17 cities. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients that were admitted between March-July, 2020. The model was then validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients.ParticipantsConsecutive symptomatic patients (≥18 years old) with laboratory confirmed COVID-19 admitted to participating hospitals. Patients who were transferred between hospitals and in whom admission data from the first hospital or the last hospital were not available were excluded, as well those who were admitted for other reasons and developed COVID-19 symptoms during their stay.Main outcome measuresIn-hospital mortalityResultsMedian (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, 53.8% were men, in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. From 20 potential predictors, seven significant variables were included in the in-hospital mortality risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859) and Spanish (0.899) validation cohorts. Our ABC2-SPH score showed good calibration in both Brazilian cohorts, but, in the Spanish cohort, mortality was somewhat underestimated in patients with very high (>25%) risk. The ABC2-SPH score is implemented in a freely available online risk calculator (https://abc2sph.com/).ConclusionsWe designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.Summary boxesWhat is already known on this topic?Rapid scoring systems may be very useful for fast and effective assessment of COVID-19 patients in the emergency department.The majority of available scores have high risk of bias and lack benefit to clinical decision making.Derivation and validation studies in low- and middle-income countries, including Latin America, are scarce.What this study addsABC2-SPH employs seven well defined variables, routinely assessed upon hospital presentation: age, number of comorbidities, blood urea nitrogen, C reactive protein, Spo2/FiO2 ratio, platelets and heart rate.This easy-to-use risk score identified four categories at increasing risk of death with a high level of accuracy, and displayed better discrimination ability than other existing scores.A free web-based calculator is available and may help healthcare practitioners to estimate the expected risk of mortality for patients at hospital presentation.

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Association between Blood Urea Nitrogen-to-creatinine Ratio and Three-Month Outcome in Patients with Acute Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190412123705 ◽

2019 ◽

Vol 16 (2) ◽

pp. 166-172 ◽

Cited By ~ 1

Author(s):

Linghui Deng ◽

Changyi Wang ◽

Shi Qiu ◽

Haiyang Bian ◽

Lu Wang ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Blood Urea Nitrogen ◽

Univariate Analysis ◽

Density Lipoprotein ◽

Hydration Status ◽

Creatinine Ratio ◽

Urea Nitrogen

Background: Hydration status significantly affects the clinical outcome of acute ischemic stroke (AIS) patients. Blood urea nitrogen-to-creatinine ratio (BUN/Cr) is a biomarker of hydration status. However, it is not known whether there is a relationship between BUN/Cr and three-month outcome as assessed by the modified Rankin Scale (mRS) score in AIS patients. Methods: AIS patients admitted to West China Hospital from 2012 to 2016 were prospectively and consecutively enrolled and baseline data were collected. Poor clinical outcome was defined as three-month mRS > 2. Univariate and multivariate logistic regression analyses were performed to determine the relationship between BUN/Cr and three-month outcome. Confounding factors were identified by univariate analysis. Stratified logistic regression analysis was performed to identify effect modifiers. Results: A total of 1738 patients were included in the study. BUN/Cr showed a positive correlation with the three-month outcome (OR 1.02, 95% CI 1.00-1.03, p=0.04). However, after adjusting for potential confounders, the correlation was no longer significant (p=0.95). An interaction between BUN/Cr and high-density lipoprotein (HDL) was discovered (p=0.03), with a significant correlation between BUN/Cr and three-month outcome in patients with higher HDL (OR 1.03, 95% CI 1.00-1.07, p=0.04). Conclusion: Elevated BUN/Cr is associated with poor three-month outcome in AIS patients with high HDL levels.

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