The role of blood urea nitrogen to serum albumin ratio in the prediction of severity and 30‐day mortality in patients with COVID‐19

Abstract

Background: Considering the role of higher blood urea nitrogen and lower serum albumin (SA) levels in deceased coronavirus disease 2019 patients, an increased blood urea nitrogen to SA (B/A) ratio may help to determine those at higher risk of critical illness. This study aimed to evaluate the correlation of the B/A ratio with severity and 30-day mortality in COVID-19 patients.Methods: A total of 433 adult patients with COVID-19 were enrolled. The laboratory markers were measured on admission. Disease severity was categorized into mild disease, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock.The mortality was followed for 30 days after admission. χ 2 test, Fisher's exact test, and Mann-Whitney U test were performed, as appropriate. Also, logistic regression and the receiver operating characteristic (ROC) curve for the B/A ratio are included.Results: Thirty-day mortality rate was 27.25%. The frequency of mild, severe pneumonia, ARDS, sepsis, and septic shock was 30.72%, 36.95%, 24.02%, 6.00%, and 2.31%, respectively. B/A ratio and SA levels were statistically different between alive and deceased patients. The mean B/A ratio was different among classified disease severities, except for mild disease. Logistic regression revealed the B/A ratio as an independent risk factor for sepsis after adjusting for age and sex. ROC analysis showed B/A ratio had an area under the curve (AUC) of 0.733 for mortality at the cutpoint of 4.944. AUC for sepsis was 0.617 which was greater than other disease severities. Conclusion:The results showed that B/A ratio and SA levels are associated with mortality of COVID-19 patients. A higher B/A ratio is, additionally, associated with COVID-19 severity, except in mild cases and it can act as an independent risk factor in sepsis. However, a greater B/A ratio is not a significant predictor of COVID-19 severity, but it can predict mortality. Therefore, we suggest this marker for clinical assessment of patients with severe COVID-19.

Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: A meta-analysis

“…3). [20][21][22][23][31][32][33] Sensitivity analysis reinforced the robustness of the result by showing no significant impact of the finding from a single study on the overall outcome. Publication bias was not investigated because only 7 studies were available.…”

“…5). [20][21][22][23]31,33] Linear regression analysis of sROC generated from mathematical computation of true and false positivity (1-specificity) of each study showed an AUC of 0.81 (95% CI = 0.77-0.84) (Fig. 6).…”

“…[18,19] Recently, several studies have also identified BUN/albumin ratio as an indicator for prognostic outcomes in patients with COVID-19. [20][21][22] Nevertheless, its efficacy for predicting in-hospital mortality based on ROC analysis varied in different observational studies with a reported area under the curve (AUC) ranging from 0.733 to 0.809. [20,23] Together with the limitation of being single-center studies in previous reports, the level of evidence supporting its clinical predictive value remains controversial.…”

Risk factors, thromboembolic events, and clinical course of New‐Onset Atrial Fibrillation among COVID‐19 hospitalized patients: A multicenter cross‐sectional analysis in Iran

“…2 The most prevalent clinical symptoms are acute respiratory distress syndrome (ARDS) and Interstitial pneumonia. 3 , 4 , 5 , 6 Also, the cardiovascular system has been reported to be frequently affected in COVID‐19 patients, and those with cardiovascular involvement are facing a greater risk of worse outcomes. 7 Atrial fibrillation (AF) is a major etiology for embolism and stroke, particularly if it is not treated with anticoagulative therapy as a preventive stroke measure.…”

“…The new coronavirus disease (COVID‐19) pandemic, precipitated by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), 1 enormously affecting worldwide communities, has resulted in exceeding 565 million afflicted individuals and over 6 million mortalities as of late July 2022 2 . The most prevalent clinical symptoms are acute respiratory distress syndrome (ARDS) and Interstitial pneumonia 3–6 . Also, the cardiovascular system has been reported to be frequently affected in COVID‐19 patients, and those with cardiovascular involvement are facing a greater risk of worse outcomes 7 .…”