Psychiatric Quarterly

, Volume 85, Issue 1, pp 111–120

Elevated Blood Urea Nitrogen and Medical Outcome of Psychiatric Inpatients

  • Peter Manu
  • Zainab Al-Dhaher
  • Sameer Khan
  • John M. Kane
  • Christoph U. Correll
Original Paper

DOI: 10.1007/s11126-013-9274-2

Cite this article as:
Manu, P., Al-Dhaher, Z., Khan, S. et al. Psychiatr Q (2014) 85: 111. doi:10.1007/s11126-013-9274-2

Abstract

Elevated blood urea nitrogen (BUN) is associated with increased severity of illness and mortality, but its predictive value has not been studied in patients admitted to free-standing psychiatric hospitals. To determine the clinical outcome of psychiatric inpatients with elevated BUN on admission and to create a quantitative method of using BUN for predicting deteriorations requiring transfers of psychiatric inpatients to a general hospital we conducted a retrospective cohort study of 939 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Transfer to a general hospital was used as a proxy marker for poor medical outcome. The score Age (years) plus BUN (mg/dL) was used in sensitivity analyses to identify patients with medical deterioration in derivation (N = 523) and validation (N = 414) samples. Fifty-two (5.5 %) patients had admission azotemia (BUN >25 mg/dL). Medical deteriorations requiring emergency transfer to a general hospital occurred in 24 (46.2 %; 95 % confidence interval = 32.6–49.8 %) of azotemic patients and 112 (12.6 %; 95 % confidence interval = 10.4–14.8 %) of those with normal BUN (p < 0.0001). Age + BUN ≥90 identified 51 transferred patients and had positive and negative predictive values of 39.8 and 89.5 %, respectively, in the entire sample. We conclude that psychiatric inpatients with BUN >25 mg/dL or Age + BUN ≥90 are at risk for medical deterioration. Free-standing psychiatric hospitals should develop models of care requiring frequent, scheduled medical follow-up and enhanced monitoring for this vulnerable populations.

Keywords

Medical outcomePsychiatric inpatientsBlood urea nitrogenAgePredictive value

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Peter Manu
    • 1
    • 2
  • Zainab Al-Dhaher
    • 1
  • Sameer Khan
    • 1
  • John M. Kane
    • 1
    • 2
  • Christoph U. Correll
    • 1
    • 2
  1. 1.Zucker Hillside HospitalNorth Shore – Long Island Jewish Health SystemGlen OaksUSA
  2. 2.Hofstra North Shore – Long Island Jewish School of Medicine at Hofstra UniversityHempsteadUSA