Blood Urea Nitrogen-to-Albumin Ratio in Predicting Long-Term Mortality in Patients Following Coronary Artery Bypass Grafting: An Analysis of the MIMIC-III Database

Abstract

BackgroundThis study examined the role of blood urea nitrogen-to-albumin ratio (BAR) in predicting long-term mortality in patients undergoing coronary artery bypass grafting (CABG).MethodsIn this retrospective cohort study, patients undergoing CABG were enrolled from the Medical Information Mart for Intensive Care III (MIMIC III) database. Patients were divided into the three groups according to the optimal cutoff values of BAR determined by X-tile software. The survival curve was constructed by the Kaplan–Meier method and multivariate Cox regression analysis was performed to explore the independent prognostic factors of 1- and 4-year mortality after CABG. The receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were calculated to estimate the accuracy of BAR in predicting the outcomes. Subgroup analyses were also carried out.ResultsA total of 1,462 patients at 4-year follow-up were included, of which 933, 293, and 236 patients were categorized into the group 1 (≤ 6.45 mg/g), group 2 (>6.45 and ≤ 10.23 mg/g), and group 3 (>10.23 mg/g), respectively. Non-survivors showed an increased level of BAR at both 1- (p < 0.001) and 4-year (p < 0.001) follow-up compared with the survivors. The patients with a higher BAR had a higher risk of 1- and 4-year mortality following CABG (33.05 vs. 14.33 vs. 5.14%, p < 0.001 and 52.97 vs. 30.72 vs. 13.08%, p < 0.001, respectively). Cox proportional hazards regression model suggested a higher BAR as an independent risk factor of 1-year mortality (HR 3.904; 95% CI 2.559–5.956; P < 0.001) and 4-year mortality (HR 2.895; 95% CI 2.138–3.921; P < 0.001) after adjusting for confounders. Besides, the receiver operating characteristic (ROC) curves showed the better predictive ability of BAR compared to other grading scores at both 1- (0.7383, 95% CI: 0.6966–0.7800) and 4-year mortality (0.7189, 95% CI: 0.6872–0.7506). Subgroup analysis demonstrated no heterogeneous results of BAR in 4-year mortality in particular groups of patient.ConclusionThis report provided evidence of an independent association between 1- and 4-year mortality after CABG and BAR. A higher BAR was associated with a higher risk of long-term mortality and could serve as a prognostic predictor in patients following CABG.

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

“…Recently, Zhao D et al used Medical Information Mart for Intensive Care (MIMIC) III databases to analyze 1,462 patients receiving CABG, and found that BAR higher than 6.45 was associated with increased long-term mortality, which was consistent with our findings [ 14 ]. In their study, Zhao D et al found a higher BAR was an independent risk factor of one-year mortality (HR 3.904; 95% CI 2.559–5.956) [ 14 ]. In the present study, we excluded patients who died during admission and focused on the 8,073 patients discharged from surgical ICUs.…”

“…We used BAR 6.0 as the cut-point value in this study to achieve the balance between patients with high and low BAR. A number of BAR relevant studies have used distinct cut-point values [ 12 – 14 , 28 , 33 ], and we hence tested the consistence of our results using distinct cut-point values of BAR. We found a consistent association between week-one BAR and one-year post-hospital mortality among the enrolled critically ill surgical patients (Supplemental Fig.…”

“…Albumin plays an essential physiological role, such as maintaining osmotic pressure as well as regulating fluid balance, and a low albumin level is a fundamental biomarker of protein-energy metabolism in critically ill surgical patients [ 9 – 11 ]. Increasing evidence shows the BUN to Albumin ratio (BAR) can predict the short-term outcome of critically ill patients [ 12 – 14 ]. For example, Dundar et al found that an elevated BAR was a predictor of in-hospital mortality in older (> 65 years of age) emergency department patients [ 12 ].…”

“…A study conducted by Ata et al found that BAR was a better independent predictor of in-hospital mortality than BUN or albumin alone in patients with severe COVID-19 infection [ 15 ]. Notably, Zhao D. et al recently used the Medical Information Mart for Intensive Care III (MIMIC III) database with 1,462 patients who underwent coronary artery bypass grafting (CABG) and found that a high BAR during admission at the intensive care unit (ICU) was associated with long-term mortality [ 14 ]. These findings highlight the crucial role of BAR in critically ill surgical patients and indicate the need to clarify the prolonged impact of BAR on post-hospital mortality in critically ill surgical patients.…”

High Fibroblast Growth Factor 23, Sialic Acids, and Albumin Modulation in Alzheimer’s Patients

“…Malondialdehyde (MDA), a reactive aldehyde and a final product of lipid peroxidation showed lower activity in the patients in in references to the controls Washeel et al, 2019), confirming studies (Gustaw-Rothenberg et al, 2010;Mohammed et al, 2021;Aysel et al, 2020). The Aβ to sialic acid binding on gangliosides in neuronal membranes promotes amyloidosis and induces cytotoxicity in AD (Rao et al, 2021;Zhao et al, 2022).…”