Elevated blood urea nitrogen and medical outcome of psychiatric inpatients

Peter Manu, Zainab Al-Dhaher, Sameer Khan, John M. Kane, Christoph U. Correll

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Elevated blood urea nitrogen (BUN) is associated with increased severity of illness and mortality, but its predictive value has not been studied in patients admitted to free-standing psychiatric hospitals. To determine the clinical outcome of psychiatric inpatients with elevated BUN on admission and to create a quantitative method of using BUN for predicting deteriorations requiring transfers of psychiatric inpatients to a general hospital we conducted a retrospective cohort study of 939 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Transfer to a general hospital was used as a proxy marker for poor medical outcome. The score Age (years) plus BUN (mg/dL) was used in sensitivity analyses to identify patients with medical deterioration in derivation (N = 523) and validation (N = 414) samples. Fifty-two (5.5 %) patients had admission azotemia (BUN >25 mg/dL). Medical deteriorations requiring emergency transfer to a general hospital occurred in 24 (46.2 %; 95 % confidence interval = 32.6-49.8 %) of azotemic patients and 112 (12.6 %; 95 % confidence interval = 10.4-14.8 %) of those with normal BUN (p <0.0001). Age + BUN ≥90 identified 51 transferred patients and had positive and negative predictive values of 39.8 and 89.5 %, respectively, in the entire sample. We conclude that psychiatric inpatients with BUN >25 mg/dL or Age + BUN ≥90 are at risk for medical deterioration. Free-standing psychiatric hospitals should develop models of care requiring frequent, scheduled medical follow-up and enhanced monitoring for this vulnerable populations.

Original languageEnglish (US)
Pages (from-to)111-120
Number of pages10
JournalPsychiatric Quarterly
Volume85
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Blood Urea Nitrogen
Psychiatry
Inpatients
Psychiatric Hospitals
General Hospitals
Confidence Intervals
Azotemia
Patient Admission
Proxy
Vulnerable Populations
Emergencies
Cohort Studies
Retrospective Studies
Mortality

Keywords

  • Age
  • Blood urea nitrogen
  • Medical outcome
  • Predictive value
  • Psychiatric inpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Medicine(all)

Cite this

Manu, P., Al-Dhaher, Z., Khan, S., Kane, J. M., & Correll, C. U. (2014). Elevated blood urea nitrogen and medical outcome of psychiatric inpatients. Psychiatric Quarterly, 85(1), 111-120. https://doi.org/10.1007/s11126-013-9274-2

Elevated blood urea nitrogen and medical outcome of psychiatric inpatients. / Manu, Peter; Al-Dhaher, Zainab; Khan, Sameer; Kane, John M.; Correll, Christoph U.

In: Psychiatric Quarterly, Vol. 85, No. 1, 2014, p. 111-120.

Research output: Contribution to journalArticle

Manu, P, Al-Dhaher, Z, Khan, S, Kane, JM & Correll, CU 2014, 'Elevated blood urea nitrogen and medical outcome of psychiatric inpatients', Psychiatric Quarterly, vol. 85, no. 1, pp. 111-120. https://doi.org/10.1007/s11126-013-9274-2
Manu, Peter ; Al-Dhaher, Zainab ; Khan, Sameer ; Kane, John M. ; Correll, Christoph U. / Elevated blood urea nitrogen and medical outcome of psychiatric inpatients. In: Psychiatric Quarterly. 2014 ; Vol. 85, No. 1. pp. 111-120.
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