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. 2019 Apr 13;19(1):63.
doi: 10.1186/s12883-019-1290-x.

Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus

Linghui Deng  1 , Shi Qiu  2   3 , Changyi Wang  1 , Haiyang Bian  4 , Lu Wang  1 , Yuxiao Li  1 , Bo Wu  5 , Ming Liu  6
Affiliations

Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus

Linghui Deng et al. BMC Neurol. .

Abstract

Background: The effect of the blood urea nitrogen (BUN) to creatinine (Cr) ratio (henceforth BUN/Cr) on haemorrhagic transformation (HT) of acute ischaemic stroke (AIS) patients is unclear.

Methods: AIS patients in the West China Hospital, Sichuan University, Chengdu, China, admitted within seven days from stroke onset (2012-2016) were included in the study. Baseline data, including BUN and Cr levels, were collected. The outcome was defined as HT during hospitalization.

Results: In this study, 1738 participants with an average age of 62.7 ± 14.0 years were included. After adjusting potential confounders (age, blood platelet, albumin, stroke severity, triglycerides and low-density lipoprotein [LDL]), multivariate logistic regression analyses indicated that BUN/Cr is independently associated with HT. The nonlinear relation between BUN/Cr and HT was explored in a dose-dependent manner, with an apparent inflection point of 30.71. On the left and right sides of the inflection point, the odds ratio (OR) and 95% confidence interval (CI) were 1.05 (1.02-1.08) and 0.96 (0.88-1.05), respectively. Interaction between BUN/Cr and diabetes mellitus (DM) and HT (P for interaction = 0.0395) was noted. BUN/Cr showed positive correlation with HT in DM patients (OR = 1.07; 95% CI: [1.02, 1.12]) but no significant relationship with HT in patients without DM.

Conclusion: BUN/Cr is significantly associated with HT in AIS patients in a linear fashion, with an apparent cut point demarcating the HT difference. When the patients have DM, BUN/Cr is positively correlated with HT. These results support a revision in how we anticipate the prognosis for AIS patients.

Keywords: Blood urea nitrogen; Creatinine; Haemorrhagic transformation; Ischaemic stroke; Nonlinear relationship.

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Conflict of interest statement

Ethics approval and consent to participate

The datasets accessed were de-identified. Given the retrospective nature of the study, requirement for informed consent was waived by the Institution review board of the West China Hospital, Sichuan University, Chengdu, People‘s Republic of China. Prof. Ming Liu granted permission to access the raw data from the registry. The procedure was approved by the Ethics Committee of the West China Hospital, Sichuan University.

Consent for publication

Participants consent for publication: Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The non-linear relationship between Bun/Cr and HT
See this image and copyright information in PMC

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