The correlation study between blood urea nitrogen to serum albumin ratio and prognosis of patients with sepsis during hospitalization

Abstract

Background Sepsis is a common critical illness in intensive care unit (ICU) and seriously threatens the life of patients. Therefore, to identify a simple and effective clinical indicator to determine prognosis is essential for the management of sepsis patients. This study was mainly based on blood urea nitrogen to albumin ratio (B/A), a comprehensive index, to explore its correlation with the prognosis of sepsis patients during hospitalization. Methods Totally, adult patients in ICU who were diagnosed with sepsis in Medical Information Mart for Intensive Care IV(MIMIC-IV) database from 2008 to 2019 were involved in this study. The study population were divided into survivors group and non-survivors group based on the prognosis during hospitalization. Restricted cubic spline (RCS) was utilized to analyze the association between B/A level and the risk of ICU all-cause mortality in patients with sepsis and determine the optimal cut-off value of B/A. The study population was divided into low B/A group and high B/A group based on the optimal cut-off value. The survival curve of ICU cumulative survival rate was draw through Kaplan–Meier method. The correlation between B/A and the prognosis of patients was conducted by multivariate Cox regression analysis. Furthermore, we performed sensitivity analyses to assess the robustness of the results. Results A total of 10,578 patients with sepsis were enrolled, and the ICU all-cause mortality was 15.89%. The patients in the non-survivors group had higher B/A values and more comorbidities than those in the survivors group. RCS showed that the risk of ICU all-cause mortality increased with the B/A level, showing a non-linear trend (χ2 = 66.82, p < 0.001). The mortality rate in the high B/A group was significantly higher than that in the low B/A group (p < 0.001). Kaplan–Meier curves revealed that compared with the low B/A group, the ICU cumulative survival rate of patients with sepsis was significantly lower in the high B/A group (log-rank test, χ2 = 148.620, p < 0.001). Further analysis of multivariate Cox proportional hazards regression showed that an elevated B/A (≥ 7.93) was an independent factor associated with ICU mortality among patients with sepsis. Conclusions An elevated B/A might be a useful prognostic indicator in patients with sepsis. This study could offer a deeper insight into treating sepsis.

Elevated Blood Urea Nitrogen to Serum Albumin Ratio Is an Adverse Prognostic Predictor for Septic shock in Intensive Care Units

“…Two retrospective studies have also found that high BAR values are associated with an adverse prognosis in sepsis 14,15 .…”

“…Prospective studies have demonstrated that hypoalbuminemia is an independent risk factor for mortality in severe infections 5,24 . BAR effectively integrates various factors including nutritional status, protein metabolism, and functional reserves of the liver and kidney 9,10,14 . Sepsis or septic shock patients frequently undergo heightened oxidative stress 25 , excessive in ammatory reactions 26 , and valvular endothelial dysfunction 27 , which promote protein hypercatabolism and leakage of albumin.…”

“…Three recent studies have shown that elevated BAR values are an unfavorable predictor of prognosis in patients with sepsis [14][15][16] . However, there has been no published research exploring the value of BAR in predicting the short-term and long-term mortality rates of patients with septic shock.…”

Association between ferritin to albumin ratio and 28-day mortality in patients with sepsis: a retrospective cohort study

“…In recent years, an increasing number of researchers have found that inflammatory biomarkers, such as ALB [ 17 ], ferritin [ 6 ], Albumin/Fibrinogen [ 18 , 19 ], hematocrit [ 20 ], platelets [ 21 ], Red blood cell distribution width [ 22 ], systemic immune-inflammation index [ 23 ], Prognostic nutrition index [ 24 ], and urea nitrogen/albumin [ 25 ], etc. FAR holds potential as a prognostic indicator for predicting the outcome of sepsis patients.…”

Relationship between blood urea nitrogen to serum albumin ratio and short-term mortality among patients from the surgical intensive care unit: a population-based real-world study

“…Blood urea nitrogen (BUN) is a byproduct of protein breakdown within the human body and is primarily eliminated through renal excretion. Consequently, its concentration serves as a significant determinant of renal function, metabolic condition, and nutritional status [ 7 ]. A case–control investigation revealed that elevated BUN levels were associated with a heightened likelihood of postoperative stroke subsequent to cardiac surgery [ 8 ].…”