Huang Dong, Yang Huan, Yu He, Wang Ting, Chen Zhu, Liang Zongan, Yao Rong
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Infectional Inpatient Ward Two, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, People's Republic of China.
Int J Gen Med. 2021 Aug 21;14:4711-4721. doi: 10.2147/IJGM.S326204. eCollection 2021.
We sought to explore the prognostic value of blood urea nitrogen (BUN) to serum albumin ratio (BAR) and further develop a prediction model for critical illness in COVID-19 patients.
This was a retrospective, multicenter, observational study on adult hospitalized COVID-19 patients from three provinces in China between January 14 and March 9, 2020. Primary outcome was critical illness, including admission to the intensive care unit (ICU), need for invasive mechanical ventilation (IMV), or death. Clinical data were collected within 24 hours after admission to hospitals. The predictive performance of BAR was tested by multivariate logistic regression analysis and receiver operating characteristic (ROC) curve and then a nomogram was developed.
A total of 1370 patients with COVID-19 were included and 113 (8.2%) patients eventually developed critical illness in the study. Baseline age (OR: 1.031, 95% CI: 1.014, 1.049), respiratory rate (OR: 1.063, 95% CI: 1.009, 1.120), unconsciousness (OR: 40.078, 95% CI: 5.992, 268.061), lymphocyte counts (OR: 0.352, 95% CI: 0.204, 0.607), total bilirubin (OR: 1.030, 95% CI: 1.001, 1.060) and BAR (OR: 1.319, 95% CI: 1.183, 1.471) were independent risk factors for critical illness. The predictive AUC of BAR was 0.821 (95% CI: 0.784, 0.858; P<0.01) and the optimal cut-off value of BAR was 3.7887 mg/g (sensitivity: 0.690, specificity: 0.786; positive predictive value: 0.225, negative predictive value: 0.966; positive likelihood ratio: 3.226, negative likelihood ratio: 0.394). The C index of nomogram including above six predictors was 0.9031125 (95% CI: 0.8720542, 0.9341708).
Elevated BAR at admission is an independent risk factor for critical illness of COVID-19. The novel predictive nomogram including BAR has superior predictive performance.
我们旨在探讨血尿素氮（BUN）与血清白蛋白比值（BAR）的预后价值，并进一步开发一种针对新型冠状病毒肺炎（COVID-19）患者危重症的预测模型。
这是一项回顾性、多中心、观察性研究，研究对象为2020年1月14日至3月9日期间来自中国三个省份的成年住院COVID-19患者。主要结局为危重症，包括入住重症监护病房（ICU）、需要有创机械通气（IMV）或死亡。临床数据在患者入院后24小时内收集。通过多因素逻辑回归分析和受试者工作特征（ROC）曲线检验BAR的预测性能，然后绘制列线图。
本研究共纳入1370例COVID-19患者，其中113例（8.2%）最终发展为危重症。基线年龄（OR：1.031，95%CI：1.014，1.049）、呼吸频率（OR：1.063，95%CI：1.009，1.120）、意识不清（OR：40.078，95%CI：5.992，268.061）、淋巴细胞计数（OR：0.352，95%CI：0.204，0.607）、总胆红素（OR：1.030，95%CI：1.001，1.060）和BAR（OR：1.319，95%CI：1.183，1.471）是危重症的独立危险因素。BAR的预测AUC为0.821（95%CI：0.784，0.858；P<0.01），BAR的最佳截断值为3.7887mg/g（灵敏度：0.690，特异度：0.786；阳性预测值：0.225，阴性预测值：0.966；阳性似然比：3.226，阴性似然比：0.394）。包含上述六个预测因子的列线图的C指数为0.9031125（95%CI：0.8720542，0.9341708）。
入院时BAR升高是COVID-19患者发生危重症的独立危险因素。包含BAR的新型预测列线图具有卓越的预测性能。
