Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

Abstract

Background Blood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored. Methods We enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan’s National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables. Results A total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127–1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247–1.811). Conclusions BAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.

Blood Urea Nitrogen-to-Albumin Ratio May Predict Mortality in Patients with Traumatic Brain Injury from the MIMIC Database: A Retrospective Study

“…Herein, the BAR further amplifies the predictive value of urea nitrogen and albumin in trauma as well as acute and critical illnesses [30]. Furthermore, BAR has been demonstrated as a reliable predictor of mortality in elderly emergency patients [31] and post-surgical patients [7,32]. Additionally, its efficacy in forecasting the prognosis of patients undergoing cardiac transplants [33], those affected by COVID-19 [34], and individuals with acute ischemic stroke [35], has been confirmed.…”

The association between blood urea nitrogen to albumin ratio and the 28 day mortality in tuberculosis patients complicated by sepsis

“…Albumin also plays a crucial role in maintaining colloid osmotic pressure and endothelial integrity as well as in regulating inflammation and immune function 11 , 12 . Previous studies have reported that elevated BUN and decreased albumin levels are closely associated with adverse outcomes in critically ill patients 13 – 15 . Several studies have validated the clinical significance of the blood urea nitrogen to albumin ratio (BAR) in predicting the prognosis of sepsis, severe pneumonia, and other diseases 16 , 17 .…”

The association between blood urea nitrogen to albumin ratio and the 28-day all-cause mortality in tuberculosis patients complicated by sepsis: a retrospective cohort study

“…Albumin also plays a crucial role in maintaining colloid osmotic pressure and endothelial integrity as well as in regulating in ammation and immune function [11,12]. Previous studies have reported that elevated BUN and decreased albumin levels are closely associated with adverse outcomes in critically ill patients [13,14,15]. Several studies have validated the clinical signi cance of the blood urea nitrogen to albumin ratio (BAR) in predicting the prognosis of sepsis, severe pneumonia, and other diseases [16,17].…”