• João Carlos Clarck Barros, Gustavo Martins Ferreira, Isabelle de Almeida Souza, Asiya Shalova, Paula Schmidt Azevedo, Bertha Furlan Polegato, Leonardo Zornoff, de PaivaSergio Alberto RuppSARDepartment of Internal Medicine, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil., Edson Luiz Favero, Taline Lazzarin, and Marcos Ferreira Minicucci.
• Department of Internal Medicine, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil.
• Am. J. Med. Sci. 2024 Aug 1; 368 (2): 153158153-158.

BackgroundEvaluate the association between serum urea at admission and during hospital stay with return of spontaneous circulation (ROSC) and in-hospital mortality in patients with in-hospital cardiac arrest (IHCA).MethodsThis retrospective study included patients over 18 years with IHCA attended from May 2018 to December 2022. The exclusion criteria were the absence of exams to calculate delta urea and the express order of "do-not-resuscitate". Data were collected from the electronic medical records. Serum admission urea and urea 24 hours before IHCA were also collected and used to calculate delta urea.ResultsA total of 504 patients were evaluated; 125 patients were excluded due to the absence of variables to calculate delta urea and 5 due to "do-not-resuscitate" order. Thus, we included 374 patients in the analysis. The mean age was 65.0 ± 14.5 years, 48.9% were male, 45.5% had ROSC, and in-hospital mortality was 91.7%. In logistic regression models, ROSC was associated with lower urea levels 24 hours before IHCA (OR: 0.996; CI95%: 0.992-1.000; p: 0.032). In addition, increased levels of urea 24 hours before IHCA (OR: 1.020; CI95%: 1.008-1.033; p: 0.002) and of delta urea (OR: 1.001; CI95%: 1.001-1.019; p: 0.023) were associated with in-hospital mortality. ROC curve analysis showed that the area under the ROC curve for mortality prediction was higher for urea 24 hours before IHCA (Cutoff > 120.1 mg/dL) than for delta urea (Cutoff > 34.83 mg/dL).ConclusionsIn conclusion, increased serum urea levels during hospital stay were associated with worse prognosis in IHCA.Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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