Psychiatric Quarterly

, Volume 85, Issue 1, pp 111–120 | Cite as

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

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 outcome Psychiatric inpatients Blood urea nitrogen Age Predictive value 

Notes

Disclosures

Drs. Manu, Al-Dhaher and Khan have nothing to disclose. Dr. Kane has been a consultant to or has received honoraria from Astra-Zeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Janssen Pharmaceutica, Johnson and Johnson, Lundbeck, Otsuka, Pfizer Inc, PgXHealth, Proteus, Vanda and Wyeth, has served on the speaker’s bureau of AstraZeneca, Bristol-Myers Squibb/Otsuka and Eli Lilly, and is a share holder of MedAvante. Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Actelion, Alexza; Bristol-Myers Squibb, Cephalon, Eli Lilly, Genentech, Gerson Lehrman Group, IntraCellular Therapies, Lundbeck, Medavante, Medscape, Merck, Janssen/J&J, Otsuka, Pfizer, ProPhase, Roche, Sunovion, Takeda, Teva, and Vanda. He has received grant support from BMS, Janssen/J&J, and Otsuka.

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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

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