TY - JOUR
T1 - Association between a 24-h increase in blood urea nitrogen and clinical outcomes in acute non-variceal upper gastrointestinal bleeding
T2 - a dual-center retrospective cohort study
AU - Bunnag, Kanit
AU - Chang, Arunchai
AU - Chuaypetch, Weeraporn
AU - Rujipattanapong, Nataree
AU - Chienwichai, Kittiphan
AU - Rugivarodom, Manus
AU - Chirapongsathorn, Sakkarin
AU - Prachayakul, Varayu
N1 - Publisher Copyright:
© The Author(s), 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2026/1/1
Y1 - 2026/1/1
N2 - Background and aim: Blood urea nitrogen (BUN) is incorporated into admission-based risk scores for acute non-variceal upper gastrointestinal bleeding (NVUGIB); however, the clinical relevance of early in-hospital BUN kinetics remains unclear. Objectives: To evaluate whether a 24-h increase in BUN is independently associated with adverse clinical outcomes in patients with acute NVUGIB. Design: Dual-center retrospective cohort study. Methods: We conducted a dual-center retrospective cohort study of adult patients with endoscopically confirmed NVUGIB admitted between 2018 and 2023. The exposure was defined as any absolute increase in BUN within 18–30 h after the baseline measurement at presentation. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, in-hospital rebleeding, red blood cell transfusion, length of hospital stay, and need for radiologic or surgical intervention. Multivariable regression was performed in a propensity score-matched cohort with confirmatory analyses in the original cohort. Results: Among 611 patients, 218 (35.7%) demonstrated a 24-h increase in BUN. Propensity score matching yielded 400 patients (200 per group). In the matched cohort, a 24-h BUN increase was independently associated with higher 30-day mortality (adjusted odds ratio (aOR) 3.307; 95% confidence interval (CI) 1.604–6.819) and in-hospital mortality (aOR 2.732; 95% CI 1.208–6.178). No independent associations were observed with rebleeding, transfusion requirements, or radiologic/surgical intervention. Conclusion: An increase in BUN within the first 24 h of hospitalization is independently associated with higher short-term mortality in acute NVUGIB. Early BUN kinetics may serve as a complementary risk marker, but prospective validation and formal predictive-performance testing are needed before clinical integration.
AB - Background and aim: Blood urea nitrogen (BUN) is incorporated into admission-based risk scores for acute non-variceal upper gastrointestinal bleeding (NVUGIB); however, the clinical relevance of early in-hospital BUN kinetics remains unclear. Objectives: To evaluate whether a 24-h increase in BUN is independently associated with adverse clinical outcomes in patients with acute NVUGIB. Design: Dual-center retrospective cohort study. Methods: We conducted a dual-center retrospective cohort study of adult patients with endoscopically confirmed NVUGIB admitted between 2018 and 2023. The exposure was defined as any absolute increase in BUN within 18–30 h after the baseline measurement at presentation. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, in-hospital rebleeding, red blood cell transfusion, length of hospital stay, and need for radiologic or surgical intervention. Multivariable regression was performed in a propensity score-matched cohort with confirmatory analyses in the original cohort. Results: Among 611 patients, 218 (35.7%) demonstrated a 24-h increase in BUN. Propensity score matching yielded 400 patients (200 per group). In the matched cohort, a 24-h BUN increase was independently associated with higher 30-day mortality (adjusted odds ratio (aOR) 3.307; 95% confidence interval (CI) 1.604–6.819) and in-hospital mortality (aOR 2.732; 95% CI 1.208–6.178). No independent associations were observed with rebleeding, transfusion requirements, or radiologic/surgical intervention. Conclusion: An increase in BUN within the first 24 h of hospitalization is independently associated with higher short-term mortality in acute NVUGIB. Early BUN kinetics may serve as a complementary risk marker, but prospective validation and formal predictive-performance testing are needed before clinical integration.
KW - 30-day mortality
KW - blood urea nitrogen
KW - non-variceal upper gastrointestinal bleeding
KW - propensity score matching
KW - risk assessment
UR - https://www.scopus.com/pages/publications/105036839862
U2 - 10.1177/17562848261438594
DO - 10.1177/17562848261438594
M3 - Article
AN - SCOPUS:105036839862
SN - 1756-283X
VL - 19
JO - Therapeutic Advances in Gastroenterology
JF - Therapeutic Advances in Gastroenterology
ER -