Blood Urea/Creatinine Ratio and Mortality in Ambulatory Patients with Heart Failure with Reduced Ejection Fraction

TY - JOUR

T1 - Blood Urea/Creatinine Ratio and Mortality in Ambulatory Patients with Heart Failure with Reduced Ejection Fraction

AU - Oswald, Andrew S.

AU - Hussain, Muhammad S.

AU - Roshan, Mohsin H.K.

AU - Pigazzani, Filippo

AU - Choy, Anna Maria

AU - Khan, Faisel

AU - Mordi, Ify R.

AU - Lang, Chim C.

N1 - Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland

PY - 2025/11/7

Y1 - 2025/11/7

N2 - Background: Chronic heart failure with reduced ejection fraction (HFrEF) is associated with high mortality, and renal dysfunction is common in these patients. Blood urea/creatinine ratio (UCR) has been identified as a potential prognostic marker, reflecting both renal function and neurohormonal activity. We assessed whether a UCR ≥ 95 at discharge from an outpatient service was associated with increased mortality.Methods: This retrospective study reviewed 337 patients (age 72.7 ± 14.3 years; 64.7% Male; Mean LVEF 33.2 ± 8.9%) with HFrEF referred to the Heart Failure Nurse Service at NHS Tayside for optimisation of heart failure medication. Cox proportional hazards models were used to assess the association between UCR and all-cause mortality.Results: Receiver operating characteristic (ROC) analysis identified a UCR threshold of 95 (area under the curve [AUC] 0.701) as predictive of mortality. Results demonstrated that a UCR ≥ 95 was independently associated with increased mortality (HR 1.85, 95% CI 1.09–3.14, p = 0.022). A high UCR was associated with increased mortality even in patients with preserved eGFR, a group typically considered at lower risk (HR 4.03, 95% CI 1.50–10.9, p = 0.006).Conclusions: These findings suggest that UCR could be a useful addition for identifying high-risk patients who may benefit from closer monitoring and more aggressive intervention following optimisation of heart failure medication.

AB - Background: Chronic heart failure with reduced ejection fraction (HFrEF) is associated with high mortality, and renal dysfunction is common in these patients. Blood urea/creatinine ratio (UCR) has been identified as a potential prognostic marker, reflecting both renal function and neurohormonal activity. We assessed whether a UCR ≥ 95 at discharge from an outpatient service was associated with increased mortality.Methods: This retrospective study reviewed 337 patients (age 72.7 ± 14.3 years; 64.7% Male; Mean LVEF 33.2 ± 8.9%) with HFrEF referred to the Heart Failure Nurse Service at NHS Tayside for optimisation of heart failure medication. Cox proportional hazards models were used to assess the association between UCR and all-cause mortality.Results: Receiver operating characteristic (ROC) analysis identified a UCR threshold of 95 (area under the curve [AUC] 0.701) as predictive of mortality. Results demonstrated that a UCR ≥ 95 was independently associated with increased mortality (HR 1.85, 95% CI 1.09–3.14, p = 0.022). A high UCR was associated with increased mortality even in patients with preserved eGFR, a group typically considered at lower risk (HR 4.03, 95% CI 1.50–10.9, p = 0.006).Conclusions: These findings suggest that UCR could be a useful addition for identifying high-risk patients who may benefit from closer monitoring and more aggressive intervention following optimisation of heart failure medication.

KW - blood urea nitrogen creatinine ratio

KW - heart failure with reduced ejection fraction

KW - neurohormonal activation

KW - outpatient

KW - prognosis

KW - renal dysfunction

UR - https://www.scopus.com/pages/publications/105023204988

U2 - 10.3390/diseases13110362

DO - 10.3390/diseases13110362

M3 - Article

C2 - 41294902

AN - SCOPUS:105023204988

SN - 2079-9721

VL - 13

JO - Diseases

JF - Diseases

IS - 11

M1 - 362

ER -