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High BUN indicates increased protein breakdown, which is associated with decreased immune function. A study shows that patients with elevated BUN (> 20 mg/dl) have an increased risk of infection (R). High BUN is associated with increased mortality in critically ill patients (R, R, R, R).
This results in a disproportionate rise in BUN levels relative to any change in serum creatinine levels. This elevation in the BUN-to-creatinine ratio is one of the laboratory indicators of decreased renal perfusion. The ratio is indicative of prerenal injury when the BUN-to-creatinine ratio is greater than 20.