Blood urea nitrogen predicts mortality in acute pancreatitis

Early changes in blood urea nitrogen can accurately identifying patients with acute pancreatitis who are at a substantially higher risk of in-hospital mortality, researchers report. Writing in the July issue of Gastroenterology, researchers from the Brigham and Women's Hospital, Boston, compared the accuracy of serial BUN and serial haemoglobin (Hgb) for predicting in-hospital mortality in patients with acute pancreatitis. The study involved 69 US hospitals and included 13,384 acute pancreatitis patients and 5819 cases with three or more BUN and Hgb measurements. During the first 48 hours of hospitalisation BUN levels were higher among patients who died than among patients who survived (p < 0.0001), the researchers found. An elevated admission BUN and an increase in BUN within the first 24 hours of hospitalisation were both independently associated with increased mortality. For every 5-mg/dL increase in BUN during the first 24 hours, the age- and gender-adjusted odds ratio for death increased by 2.2. In contrast, a reduction in BUN during the first 24 hours of hospitalisation was associated with significantly improved survival. Of six routinely collected admission laboratory tests examined (BUN, calcium, creatinine, WBC count, Hgb, and glucose), serial BUN measurement was "the most valuable" single test for predicting in-hospital mortality, the researchers said. Serial measurement of BUN, "provides valuable additional clinical information regarding the efficacy of initial resuscitation as well as potential disease progression," they concluded. Gastroenterology 2009;137:129-135....