Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients

Ryu, Seung Ho; Oh, Se Kwang; Cho, Sung Uk; You, Yeonho; Park, Jung Soo; Min, Jin Hong; Jeong, Wonjoon; Cho, Yong chul; Ahn, Hong Joon; Kang, Changshin

doi:10.1016/j.ajem.2020.02.045

Cited by 67 publications

(68 citation statements)

References 24 publications

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“…Elevated admission BUN/creatinine ratio is strongly associated with increased mortality of renal dysfunction with decompensated heart failure and as novel biomarker of critical illness-associated catabolism [24,25]. A recent study reported that the BCR was associated with poorer survival outcomes in hospital-acquired pneumonia and aspiration pneumonia, where the AUC of predicting the 30-day mortality and 28-day mortality were less than 0.7 [13,14]. In this study, the AUC of BCR predicting in-hospital mortality was 0.768, especially, the above normal range of BCR had greater predictive ability, with higher AUC values in predicting mortality in patients with COVID-19 pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated BUN level has been reported as a predictor of worse outcomes in patients with heart failure and BUN level >7mmol/ was one of the criteria of CURB-65 scoring for community acquired pneumonia [10,11]. Recent studies have shown that the BUN to serum albumin ratio is an important prognostic factor of mortality and disease severity in patients with aspiration, hospital-acquired and community-acquired pneumonia [12][13][14]. Several studies have suggested that an elevated ratio of BUN to creatinine (denoted as BCR) is associated with prolonged intensive care and mortality in patients with critical illness [7,15].In addition, BCR is a poor prognostic risk factor for chronic heart failure, ischemic stroke and serious disease that persists after major trauma [7,16,17].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of a Blood Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients

Liu

Wang

Zhao

et al. 2020

Preprint

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Background: The novel coronavirus disease (COVID-19) is leading to high morbidity and mortality. This study aimed to test whether blood urea nitrogen-to-creatinine ratios (BCR) is a predictor of poor prognosis in patients with COVID-19. Method: From 9,165 generally healthy subjects, we calculated ranges of “normal” BCR values. 416 COVID-19 patients were randomly assigned to training cohort and validation cohort contained 337, 79 patients, respectively. The prognostic ability of abnormal BCR range was assessed using a Logistic regression. Development a nomogram for predicting in-hospital mortality incorporated age, sex and BCR. The model discrimination was assessed using the calibration curves and concordance index in training and validation cohort. The predictive accuracy and clinical values of the nomogram was measured by decision curve analysis (DCA) and clinical impact curve analysis (CICA). Results: Among 337 COVID-19 patients, 13.4% and 11.3% were classified into higher and lower than normal range group, respectively. The BCR was identified as an independent risks factor for death in COVID-19 patients (P<0.0001), with area under the curve (AUC) 0.768; 95%CI: 0.717-0.819). Kaplan-Meier curves for all-cause mortality outcomes showed that patients with above normal range of BCR had worse prognosis (p<0.0001). Logistic regression analysis revealed that BCR above the normal range was independently associated with death in COVID-19 patients (Odds ratio 7.54; 95%CI: 1.55-36.66; P=0.012). ROC curves showed that the nomogram had good discrimination in the training cohort (AUC 0.838; 95%CI 0.795–0.880) and the validation cohort (AUC 0.929; 95%CI 0.869-0.989). Using maximum Youden index, the cutoff values of 59.8 points, the sensitivity and specificity were 75.4% and 81%. The calibration curves showed good agreement between nomogram prediction and actual observation. DCA and CICA indicated the clinical usefulness of the prediction nomogram. Conclusion: BCR was a useful prognostic factor for COVID-19 patients. Development of an individualized prediction nomogram BCR-based, which can effectively predict the risk of mortality, and then, help clinicians to improve individual treatment, make clinical decisions timely and early.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of a Blood Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients

Liu

Wang

Zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Elevated BUN levels are a predictor of worse outcome in patients with heart failure [7] . Recent studies have shown that the BUN to serum albumin ratio is an important prognostic factor of mortality and disease severity in aspiration pneumonia, hospital-acquired pneumonia and community-acquired pneumonia (CAP) [8] , [9] , [10] . Moreover, serum albumin levels were also identified as prognostic factors for pneumonia diseases and demonstrated fair discriminative performance in the prediction of in-hospital mortality [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients

Cheng

Wang

et al. 2020

International Journal of Antimicrobial Agents

123

101

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Highlights Initial blood urea nitrogen (BUN) and D-dimer levels were associated with mortality in COVID-19 patients. Combination of BUN ≥ 4.6 mmol/L and D-dimer ≥ 0.845 μg/mL can identify patients at high risk of in-hospital mortality. Development of a nomogram model based on initial BUN and D-dimer levels. The nomogram could be a suitable and useful individualised tool to predict mortality in COVID-19 patients.

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“…In addition, high BUN and low serum Alb levels were poor prognostic factors for patients with CAP [13][14][15][16], and the BUN/Alb ratio was useful in predicting the mortality of patients with CAP [19,35]. Moreover, the BUN/Alb ratio was also a useful marker for predicting the mortality in patients with HAP and aspiration pneumonia [17,18]. These ndings are consistent with the present study, which revealed that the increased BUN/Alb ratio before treatment was signi cantly associated with 30-day mortality in patients with non-HIV PcP.…”

Section: Discussionmentioning

confidence: 99%

“…High BUN and low serum Alb levels are considered as poor prognostic factors in patients with CAP [13][14][15][16]. In addition, a high BUN-to-serum Alb (BUN/Alb) ratio is reportedly a useful marker of mortality from CAP, hospital-acquired pneumonia (HAP), and aspiration pneumonia [17][18][19]. A previous report suggested that A-DROP may underestimate the severity of non-HIV PcP [20].…”

Section: Introductionmentioning

confidence: 99%

A-DROP and Blood Urea Nitrogen-to-Serum Albumin Ratio are Useful in Assessing the Severity of Pneumocystis Pneumonia in Patients Without Human Immunodeficiency Virus Infection: A Retrospective Study

Akahane¹,

Ushiki²,

Kosaka³

et al. 2020

Preprint

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Background: There is an increasing incidence of Pneumocystis pneumonia among individuals without the human immunodeficiency virus (HIV) infection (non-HIV Pneumocystis pneumonia). However, the prognostic factors for patients with non-HIV Pneumocystis pneumonia have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio, which is reported to be predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV Pneumocystis pneumonia. In this study, we analyzed the prognostic factors for non-HIV Pneumocystis pneumonia and evaluated the effectiveness of A-DROP and the blood urea nitrogen-to-serum albumin ratio as prognostic factors.Methods: This retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV Pneumocystis pneumonia between January 2003 and May 2019 at five medical facilities. Prognostic factors associated with the 30-day mortality were assessed using multiple logistic regression analysis.Results: Among the 102 patients with non-HIV Pneumocystis pneumonia, 46 (45.1%) had autoimmune diseases, 19 (18.6%) had hematological malignancies, 18 (17.7%) had solid malignancies, and 19 (18.6%) had other diseases. The 30-day mortality rate for non-HIV Pneumocystis pneumonia was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and a significantly higher age, corticosteroid dosage at the onset of Pneumocystis pneumonia, alveolar–arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and blood urea nitrogen-to-serum albumin ratio. The results of multivariate analysis showed that a high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation were significantly associated with the 30-day mortality risk.Conclusions: A high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation are independent prognostic predictors of mortality risk in patients with non-HIV Pneumocystis pneumonia.

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Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients

Cited by 67 publications

References 24 publications

Diagnostic Performance of a Blood Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients

Diagnostic Performance of a Blood Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients

Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients

A-DROP and Blood Urea Nitrogen-to-Serum Albumin Ratio are Useful in Assessing the Severity of Pneumocystis Pneumonia in Patients Without Human Immunodeficiency Virus Infection: A Retrospective Study

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