rasio BUN/kreatinin sebagai predictor kematian pasien gagal jantung akut tanpa sindrom koroner akut

Septiana Wahyu Alifiah, dr. Ira Puspitawati, M.Kes., Sp.PK, Subsp.N.R. (K); Prof. Dr. dr. Osman Sianipar, DMM., M.Sc., Sp.PK, Subsp.P.I (K), Subsp.Onk.K (K)

2025 | Tesis-Spesialis | S2 Ilmu Patologi Klinik

Latar Belakang:

Gagal jantung mempunyai prognosis yang buruk. Di Indonesia, angka kematian dalam waktu 30 hari sebesar 17%. Gagal jantung akut dapat mengganggu fungsi ginjal akibat penurunan curah jantung dan terkait dengan aktivasi neurohormonal meliputi aktivasi the sympathetic nervous system (SNS), renin–angiotensin–aldosterone system (RAAS), dan arginine vasopressin (AVP). Kreatinin serum umum digunakan untuk menilai fungsi ginjal, walaupun memiliki keterbatasan. Kadar blood urea nitrogen (BUN) tidak bisa diandalkan sebagai penanda fungsi ginjal, karena lebih mencerminkan aktivasi neurohormonal dibandingkan perubahan kreatinin. Rasio BUN/kreatinin diusulkan menjadi indikator aktivitas neuhormonal yang memiliki dampak pada prognosis gagal jantung.   

Tujuan: 

Penelitian ini bertujuan untuk mengkaji risiko kematian pada pasien gagal jantung akut tanpa sindrom koroner akut berbasis rasio BUN/kreatinin.

Metode: 

Penelitian ini merupakan penelitian kohort retrospektif pada kelompok pasien gagal jantung akut tanpa sindrom koroner akut berusia ? 18 tahun. Kelompok terpapar adalah subjek dengan rasio BUN/kreatinin ? 19,37. Terjadinya kematian diamati dalam kurun waktu 90 hari setelah awal masuk rawat inap. Analisis kesintasan dievaluasi menggunakan Kaplan-Meier dan log-rank test. Hazard ratio diperoleh melalui Cox regression.

Hasil: 

Kematian pada kelompok subjek dengan rasio BUN/kreatinin ? 19,37 adalah 34,9%, sedangkan kematian pada kelompok subjek dengan rasio BUN/kreatinin < 19 xss=removed xss=removed xss=removed xss=removed>

Simpulan: 

Kelompok pasien gagal jantung akut tanpa sindrom koroner akut dengan rasio BUN/kreatinin ? 19,37 memiliki risiko kematian 90 hari sebesar 2,23 kali lebih tinggi dibanding kelompok pasien dengan rasio BUN/kreatinin < 19>

Background: 

Heart failure has a poor prognosis. In Indonesia, the 30-day mortality rate is 17%. Acute heart failure can impair kidney function due to reduced cardiac output and is associated with neurohormonal activation, including activation of the sympathetic nervous system (SNS), renin–angiotensin–aldosterone system (RAAS), and arginine vasopressin (AVP). Serum creatinine is commonly used to assess kidney function, although it has limitations. Blood urea nitrogen (BUN) levels are not reliable as markers of kidney function, as they reflect neurohormonal activation rather than changes in creatinine. The BUN/creatinine ratio has been proposed as an indicator of neurohormonal activity that impacts the prognosis of heart failure.

Objective: 

This study aims to assess the risk of death in patients with acute heart failure without acute coronary syndrome based on BUN/creatinine ratio.

Method: 

This study is a retrospective cohort study of a group of patients with acute heart failure without acute coronary syndrome aged ? 18 years. The exposed group consists of subjects with a BUN/creatinine ratio ? 19.37. Mortality was observed within 90 days of hospital admission. Survival analysis was evaluated using the Kaplan-Meier method and log-rank test. Hazard ratios were obtained through Cox regression.

Result: 

The mortality rate in the group of subjects with a BUN/creatinine ratio ? 19.37 was 34.9%, while the mortality rate in the group of subjects with a BUN/creatinine ratio < 19 xss=removed xss=removed xss=removed xss=removed>

Conclusion: 

Patients with acute heart failure without acute coronary syndrome who had a BUN/creatinine ratio ? 19.37 had a 2.23-fold higher risk of 90-days mortality compared with those with a ratio < 19>

Kata Kunci : gagal jantung akut, rasio BUN/kreatinin, kematian