The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department

Abstract

Introduction Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. Methods A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. Results Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49–73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38–38.31] and 14.43 [10.84–20.42], respectively [ p < 0.001]; BAR: 6.7 [4.7–10.1] and 3.4 [2.5–5.2], respectively [ p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 ± 0.58 and 4.13 ± 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). Conclusion The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels.

BT Görüntüleme Bulgularına Göre Tanı Alan COVID-19 Pozitif ve Olası Hastaları Karşılaştırarak Klinik Karar Vermede BT'nin Kullanılabilirliğinin Araştırılması

“…In another study, CT findings were found to be correlated with the severity and duration of the symptoms of COVID-19, and similar to our study, lymphocyte count was found to be negatively correlated with lung involvement (22). Again, there are studies showing that laboratory findings, such as CRP, ferritin, D-dimer, and lactate are elevated in COVID-19 patients and correlate with the disease severity and mortality (4,(23)(24)(25).…”

Prognostic Value of Blood Urea Nitrogen to Serum Albumin Ratio in Intensive Care Unit Patients with Lung Cancer

“… 30 Moreover, Huang et al conducted a retrospective, observational study of 602 patients and demonstrated that elevated BAR at admission is an independent risk factor for in-hospital mortality in coronavirus disease patients (2019). 31 Our study added the evidence that BAR was a reliable predictor for prognosis of patients with disease of the respiratory system. We firstly found that initial BAR could be an independent predictor for in-hospital mortality even after adjusting confounding factors in patients with lung cancer who were admitted to ICU.…”

Blood Urea Nitrogen to Serum Albumin Ratio (BAR) Predicts Critical Illness in Patients with Coronavirus Disease 2019 (COVID-19)

“…As Küçükceran reported, the AUC of BAR in COVID-19 was 0.809 and BAR>3.9 mg/g was associated with increased in-hospital mortality (OR: 10.448; 95% CI: 5.562–19.626). 10 It is noted that the OR was calculated by using univariate logistic regression analysis. Furthermore, there is scarce data on the predictive value for critical illness of BAR in COVID-19.…”

“… 8 , 9 Moreover, it has also been reported that BAR is a more reliable predictor than BUN and albumin levels for predicting mortality in COVID-19 patients in the emergency department recently. 10 However, above studies still suffer from some limitations, such as single-center design, medium sample size, potential unadjusted confounding factors, etc.…”