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Elevated Blood Urea Nitrogen and Medical Outcome of Psychiatric Inpatients

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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.

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References

  1. Kirtane AJ, Leder DM, Waikar SS, Chertow GM, Ray KK, Pinto DS, Karmpaliotis D, Burger AJ, Murphy SA, Cannon CP, Braunwald E, Gibson CM, TIMI Study Group: Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. Journal of the American College of Cardiology 45(11):1781–1786, 2005

    Article  CAS  PubMed  Google Scholar 

  2. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ, Adhere Scientific Advisory Committee, Study Group, and Investigators: Risk stratification for in-hospital mortality in acutely decompensated heart failure: Classification and regression tree analysis. JAMA 293(5):572–580, 2005

    Google Scholar 

  3. Cauthen CA, Lipinski MJ, Aggate A, Appleton D, Nusca A, Varma A, Goudreau E, Cowley MJ, Vetrovec GW: Relation of blood urea nitrogen to long-term mortality in patients with heart failure. The American Journal of Cardiology 101(11):1643–1647, 2008

    Article  CAS  PubMed  Google Scholar 

  4. Rehman SU, Martinez-Rumayor A, Mueller T, Januzzi JL Jr: Independent and incremental prognostic value of multimarker testing in acute dyspnea: Results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. Clinica Chimica Acta 392(1–2):41–45, 2008

    Article  CAS  Google Scholar 

  5. Baggish AL, Lloyd-Jones DM, Blatt J, Richards AM, Lainchbury J, O’Donoghue M, Sakhuja R, Chen AA, Januzzi JL: A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: Derivation, validation and incorporation into a bedside programme. Heart 94(8):1032–1037, 2008

    Article  CAS  PubMed  Google Scholar 

  6. Fine MJ, Aubie TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN: A prediction rule to identify low-risk patients with community-acquired pneumonia. The New England Journal of Medicine 336(4):243–250, 1997

    Article  CAS  PubMed  Google Scholar 

  7. Raz R, Dyachenko P, Levy Y, Flatau E, Reichman N: A predictive model for the management of community-acquired pneumonia. Infection 31(1):3–8, 2003

    Article  CAS  PubMed  Google Scholar 

  8. Espana PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, Bilbao A, Quintana JM. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. The American Journal of Respiratory and Critical Care Medicine 174(11):1249–1256, 2006

    Article  Google Scholar 

  9. Mackinney-Novelo I, Barahona-Garrido J, Castillo-Albarran F, Santiago-Hernandez JJ, Mendez-Sanchez N, Uribe M, Chavez-Tapia N: Clinical course and management of acute hepatitis A infection in adults. Annals of Hepatology 11(5):652–657, 2012

    CAS  PubMed  Google Scholar 

  10. Tandon P, Garcia-Tsao G: Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clinical Gastroenterology and Hepatology 9(3):260–265, 2011

    Article  PubMed Central  PubMed  Google Scholar 

  11. Rhoney DH, Parker D Jr, Millis SR, Whittaker P: Kidney dysfunction at the time of intracerebral hemorrhage is associated with increased in-hospital mortality: A retrospective observational cohort study. Neurological Research 34(5):518–521, 2012

    Article  PubMed  Google Scholar 

  12. Lee CC, Wu CJ, Chi CH, Lee NY, Chen PL, Lee HC, Chang CM, Ko NY, Ko WC: Prediction of community-onset bacteremia among febrile adults visiting an emergency department: Rigor matters. Diagnostic Microbiology and Infectious Disease 73(2):168–73, 2012

    Article  PubMed  Google Scholar 

  13. Kaya E, Dervisoglu A, Polat C: Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World Journal of Gastroenterology 13(22):3090–3094, 2007

    CAS  PubMed  Google Scholar 

  14. Faisst M, Wellner UF, Utzolino S, Hopt UT, Keck T: Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis. Journal of Critical Care 25(1):105–111, 2010

    Article  CAS  PubMed  Google Scholar 

  15. Wu BU, Bakker OJ, Papachristou GI, Besselink MG, Repas K, vanSantvort HC, Muddano V, Singh VK, Whitcomb DC, Gooszen HG, Banks PA: Blood urea nitrogen in the early assessment of acute pancreatitis: An international validation study. Archives of Internal Medicine 171(7):669–676, 2011

    Google Scholar 

  16. Talukdar R, Nechutova H, Clemens M, Vege SS: Could rising BUN predict the future development of infected pancreatic necrosis? Pancreatology 13(4):355–359, 2013

    Article  CAS  PubMed  Google Scholar 

  17. Chen SC, Tsai SJ, Chen CH, Huang CC, Lin DB, Wang PH, Chen CC, Lee MC: Predictors of mortality in patients with pyogenic liver abscess. Netherlands Journal of Medicine 66(6):196–203, 2008

    CAS  PubMed  Google Scholar 

  18. Barra S, Providencia R, Caetano F, Almeida I, Paiva L, Dinis P, Leitao Marques A: BLEED-myocardial infarction score: Predicting mid-term post-discharge bleeding events. World Journal of Cardiology 5(6):196–206, 2013

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF: Outcomes after esophagectomy: A ten-year prospective cohort [discussion 222]. Annals of Thoracic Surgery 75(1):217–22, 2003

    Google Scholar 

  20. Beier K, Eppanapally S, Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB: Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of “normal” creatinine. Critical Care Medicine 39(2):305–313, 2011

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Singh G, Peterson EL, Wells K, Williams LK, Lanfear DE: Comparison of renal predictors for in-hospital and postdischarge mortality after hospitalized heart failure. Journal of Cardiovascular Medicine (Hagerstown) 13(4):246–253, 2012

    Article  Google Scholar 

  22. Pompei P, Charlson ME, Ales K, MacKenzie CR, Norton M: Relating patient characteristics at the time of admission to outcomes of hospitalization. Journal of Clinical Epidemiology 44(10):1063–1069, 1991

    Article  CAS  PubMed  Google Scholar 

  23. Bloom JD, Krishan B, Lockey C: The majority of inpatients psychiatric beds should not be appropriate by the forensic system. Journal of the American Academy of Psychiatry 36:438–442, 2008

    Google Scholar 

  24. De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JM, Uwakwe R, Leucht S: Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10(1):52–77, 2011

    Google Scholar 

  25. Leung MW, Xiong GL, Leamon MH, McCarron RM, Hales RE: General-medical hospital admissions from a public inpatient psychiatric health facility: A review of medical complications over 30 months. Psychosomatics 51(6):498–502, 2010

    Article  PubMed  Google Scholar 

  26. Passov V, Rundell JR: Analysis of transfers from a medical-psychiatry inpatient unit to a medical-surgical unit within 48 hours of admission. Psychosomatics 49(6):535–7, 2008

    Article  PubMed  Google Scholar 

  27. Kazory A: Emergence of blood urea nitrogen as a biomarker of neurohormonal activation in heart failure. The American Journal of Cardiology 106(5):694–700, 2010

    Article  CAS  PubMed  Google Scholar 

  28. Gao M, Zhang L, Liu Y, Yang M, Wang N, Wang K, Ou D, Liu M, Chen G, Liu K, Xiao X: Use of blood urea nitrogen, creatinine, interleukin-6, granulocyte-macrophage colony stimulating factor in combination to predict the severity and outcome of abdominal sepsis in rats. Inflammation Research 61(8):889–897, 2012

    Article  CAS  PubMed  Google Scholar 

  29. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. Journal of the American Geriatrics Society 52(4):625–34, 2004

    Article  PubMed  Google Scholar 

  30. Fried LP, Tangen, CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56(3):146–156, 2001

    Article  Google Scholar 

  31. Inouye SK, Studenski S, Tinetti ME,Kuchel GA: Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society 55(5):780–791, 2007

    Article  PubMed Central  PubMed  Google Scholar 

  32. Manu P, Grudnikoff E, Khan S, Kremen NJ, Greenwald BS, Kane JM, Correll CU: Medical outcome of patients with dementia in a free-standing psychiatric hospital. Journal of Geriatric Psychiatry and Neurology 26(1):29–33, 2013

    Article  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA

    Peter Manu, Zainab Al-Dhaher, Sameer Khan, John M. Kane & Christoph U. Correll

  2. Hofstra North Shore – Long Island Jewish School of Medicine at Hofstra University, Hempstead, NY, USA

    Peter Manu, John M. Kane & Christoph U. Correll

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  1. Peter Manu
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  2. Zainab Al-Dhaher
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  5. Christoph U. Correll
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Correspondence to Peter Manu.

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Manu, P., Al-Dhaher, Z., Khan, S. et al. Elevated Blood Urea Nitrogen and Medical Outcome of Psychiatric Inpatients. Psychiatr Q 85, 111–120 (2014). https://doi.org/10.1007/s11126-013-9274-2

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  • DOI: https://doi.org/10.1007/s11126-013-9274-2

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