The role of BUN/Creatinine ratio in determining the severity of gastrointestinal bleeding and bleeding localization

Objective: The aim of the study is to evaluate an established biomarker such as blood urea nitrogen (BUN)/Creatinine ratio in predicting upper gastrointestinal bleeding versus lower GI and stratify its severity. The aim of this study is to evaluate the diagnostic performance in clinical practice and predestination as a prognostic factor, including admission to an intensive care unit (ICU) or mortality rate for BUN/Creatinine ratio.
Methods: A total of 300 patients controlled in our hospital between January 2022 and January 2024, were evaluated retrospectively due to hospitalization by acute GI bleeding. Gastroscopy and/or colonoscopy were used to stratify patients into the upper or lower GI bleeding group. Data included demographic information, clinical presentation history and vital signs, comorbidity status, medication use, clinical outcomes and laboratory tests including hemoglobin, hematocrit, urea, creatinine levels and so on. The BUN/Creatinine ratio was determined and correlated with site, as well as severity of bleeding. Statistical techniques, such as logistic regression and receiver operating characteristic (ROC) analysis, were used to assess the diagnostic performance of the ratio and to choose a cut-off value.
Results: Among the 300 patients, 215 (71,7% had upper GI bleeding, and 85 (28,3% had lower GI bleeding. Hematemesis and melena were significantly associated with upper GI bleeding, whereas hematochezia was more common in lower GI bleeding. Patients with upper GI bleeding had significantly higher BUN, urea, and BUN/Creatinine ratios, while hemoglobin and hematocrit levels were lower. The optimal BUN/Creatinine cut-off value of 23,3 demonstrated high sensitivity (89,3%) and specificity (94,1%) for distinguishing between upper and lower GI bleeding. Multivariate analysis revealed BUN/Creatinine ratio, hematochezia and endoscopic intervention as an independent predictor of bleeding location. Patients with BUN/Creatinine ratio>23,3 showed increased frequency of red blood cell transfusion, endoscopic intervention, and mortality.
Conclusion: The BUN/Creatinine ratio is a sensitive, noninvasive biomarker for distinguishing between upper and lower GI bleed and severity. Its introduction into clinical practice may enhance the process decision and the patient care, especially in critical care contexts. Additional research is indicated to confirm these results and to define standardized cut-off values for wider use.

BUN/Kreatinin oranýnýn gastrointestinal kanama þiddeti ve kanama lokalizasyonunun belirlenmesindeki rolü

Amaç: Bu çalýþmanýn amacý, üst gastrointestinal kanama ile alt gastrointestinal kanamayý ayýrt etmede ve þiddetini sýnýflandýrmada kan üre azotu (BUN)/Kreatinin oraný gibi yerleþik bir biyomarkerin prognostik deðerini deðerlendirmektir. Ayrýca, bu çalýþmanýn amacý, klinik pratiðe yönelik tanýsal performansýný ve yoðun bakým ünitesine (YBÜ) kabul veya mortalite oraný gibi prognoz faktörü olarak kullanýmýný deðerlendirmektir.
Metod: Ocak 2022 ile Ocak 2024 arasýnda hastanemizde akut gastrointestinal kanama nedeniyle yatýrýlan toplam 300 hasta retrospektif olarak deðerlendirildi. Gastroskopi ve/veya kolonoskopi kullanýlarak hastalar üst veya alt gastrointestinal kanama gruplarýna ayrýldý. Veriler arasýnda demografik bilgiler, klinik presentasyon öyküsü, vital bulgular, komorbidite durumu, ilaç kullanýmý, klinik sonuçlar ve hemoglobin, hematokrit, üre, kreatinin düzeyleri gibi laboratuvar testleri yer aldý. BUN/Kreatinin oraný belirlendi ve kanamanýn yeri ile þiddeti ile korelasyonu incelendi. Tanýsal performansý deðerlendirmek ve bir cut-off deðeri seçmek için lojistik regresyon ve alýcý iþletim karakteristiði (ROC) analizi gibi istatistiksel teknikler kullanýldý.
Bulgular: 300 hasta arasýnda, 215’i (%71,7) üst gastrointestinal kanama, 85’i (%28,3) ise alt gastrointestinal kanama geçirmiþti. Hematemez ve melena üst gastrointestinal kanama ile anlamlý þekilde iliþkilidir, oysa hematoþezia alt gastrointestinal kanama ile daha yaygýndý. Üst gastrointestinal kanamasý olan hastalar, daha yüksek BUN, üre ve BUN/Kreatinin oranlarýna sahipken, hemoglobin ve hematokrit seviyeleri daha düþüktü. 23,3 deðerindeki optimal BUN/Kreatinin cut-off deðeri, üst ve alt gastrointestinal kanamalarý ayýrt etmede yüksek duyarlýlýk (%89,3) ve özgüllük (%94,1) göstermiþtir. Çok deðiþkenli analiz, BUN/Kreatinin oraný, hematoþezia ve endoskopik müdahaleyi, kanamanýn yerini baðýmsýz olarak tahmin eden faktörler olarak belirlemiþtir. BUN/kreatinin oraný >23,3 olan hastalarda, kýrmýzý kan hücresi transfüzyonu, endoskopik müdahale ve mortalite sýklýðý artmýþtýr.
Sonuç: BUN/Kreatinin oraný, üst ve alt gastrointestinal kanama ile þiddetini ayýrt etmek için duyarlý, non-invaziv bir biyomarkerdir. Klinik pratiðe girmesi, özellikle kritik bakým baðlamlarýnda hasta bakýmýný ve karar verme sürecini iyileþtirebilir. Bu sonuçlarý doðrulamak ve daha geniþ kullaným için standart cut-off deðerlerini belirlemek amacýyla ek araþtýrmalara ihtiyaç vardýr. (NCI-2024-12-4)