A high urea-to-creatinine ratio predicts long-term mortality independent of acute kidney injury among patients hospitalized with an infection

Elisabeth C van der Slikke, Bastiaan S Star, Vincent D de Jager, Marije B M Leferink, Lotte M Klein, Vincent M Quinten, Tycho J Olgers, Jan C Ter Maaten, Hjalmar R Bouma*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

50 Downloads (Pure)


Acute kidney injury (AKI) occurs frequently in patients with sepsis. Persistent AKI is, in contrast to transient AKI, associated with reduced long-term survival after sepsis, while the effect of AKI on survival after non-septic infections remains unknown. As prerenal azotaemia is a common cause of transient AKI that might be identified by an increased urea-to-creatinine ratio, we hypothesized that the urea-to-creatinine ratio may predict the course of AKI with relevance to long-term mortality risk. We studied the association between the urea-to-creatinine ratio, AKI and long-term mortality among 665 patients presented with an infection to the ED with known pre-existent renal function. Long-term survival was reduced in patients with persistent AKI. The urea-to-creatinine ratio was not associated with the incidence of either transient or non-recovered AKI. In contrast, stratification according to the urea-to-creatinine-ratio identifies a group of patients with a similar long-term mortality risk as patients with persistent AKI. Non-recovered AKI is strongly associated with all-cause long-term mortality after hospitalization for an infection. The urea-to-creatinine ratio should not be employed to predict prerenal azotaemia, but identifies a group of patients that is at increased risk for long-term mortality after infections, independent of AKI and sepsis.

Original languageEnglish
Article number15649
Number of pages10
JournalScientific Reports
Issue number1
Publication statusPublished - 24-Sep-2020


  • Acute Kidney Injury/complications
  • Aged
  • Creatinine/blood
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Infections/blood
  • Male
  • Prognosis
  • Risk Factors
  • Urea/blood

Cite this