ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1569218
Relationship between Blood Urea Nitrogen and 28-day All-cause Mortality in Patients with Acute Pulmonary Edema: A Retrospective Analysis of the MIMIC-IV Database
Provisionally accepted
- 1Lichuan People's Hospital, Lichuan, China
- 2Hubei University of Medicine, Shiyan, Hubei, China
- 3Qixingguan District People's Hospital, Bijie, China
- 4Lichuan People's Hospital, fuzhou, China
- 5Shanghai Public Health Clinical Center, Fudan University, Shanghai, Shanghai Municipality, China
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Abstract Background: Acute pulmonary edema is a severe clinical syndrome with high mortality. Blood Urea Nitrogen (BUN) levels, which indicate renal function and metabolic state, may have prognostic value in critically ill patients. However, their relationship with outcomes in acute pulmonary edema remains unclear. Objective: This study aims to investigate the association between admission BUN levels and 28-day all-cause mortality in patients with acute pulmonary edema. Methods: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, covering the period from 2008 to 2019. It included adult patients diagnosed with acute pulmonary edema. Patients were divided into four groups based on their BUN levels. Cox regression models, restricted cubic spline (RCS) curves, Kaplan-Meier analysis, and subgroup analyses were used to assess the relationship between BUN levels and mortality. Results: A total of 1,094 patients were included in the study. Univariate Cox regression analysis revealed a positive correlation between BUN levels and 28-day mortality (HR = 1.02, 95% CI: 1.01-1.02, P < 0.001). Multivariate analysis confirmed BUN as an independent predictor of mortality (HR = 1.02, 95% CI: 1.01-1.02, P < 0.001). The RCS curve indicated a nonlinear relationship, and Kaplan-Meier analysis showed lower survival in the higher BUN groups (P < 0.001). Subgroup analysis found the association to be significant across all subgroups. Conclusion: Admission BUN levels predict 28-day all-cause mortality in patients with acute pulmonary edema. Clinically, BUN monitoring should be emphasized, and individualized prognostic and treatment strategies should be developed to improve outcomes.
Keywords: Acute pulmonary edema, Blood Urea Nitrogen, 28-day all-cause mortality, prognosis, MIMIC-IV database
Received: 31 Jan 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 Tu, Liu, Huang, Zeng, Cai and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Guang Tu, Lichuan People's Hospital, Lichuan, China
Chunyan - Y Wang, Shanghai Public Health Clinical Center, Fudan University, Shanghai, Shanghai Municipality, China
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