Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
Anhui Province Key Laboratory of Clinical and Preclinical Research in Respiratory Disease, Bengbu, China.
Sci Rep. 2023 Jun 20;13(1):10013. doi: 10.1038/s41598-023-37127-8.
To investigate the ability of the ratio of blood urea nitrogen (BUN) to serum albumin ratio (BAR) in patients with sepsis in intensive care units (ICUs) to predict the prognosis of short-and long-term death. Data are from the Marketplace for Intensive Care Medical Information IV (MIMIC-IV v2.0) database for patients with sepsis as defined by SEPSIS-3. The primary outcome was 30-day mortality and the secondary outcome was 360-day mortality. Kaplan-Meier (KM) survival curves were plotted to describe differences in BAR mortality in different subgroups and area under the curve (AUC) analysis was performed to compare the predictive value of sequential organ failure assessment (SOFA), BAR, blood urea nitrogen (BUN) and albumin. Multivariate Cox regression models and subgroup analysis were used to determine the correlation between BAR and 30-day mortality and 360-day mortality. A total of 7656 eligible patients were enrolled in the study with a median BAR of 8.0 mg/g, including 3837 in the ≤ 8.0 group and 3819 in the BAR > 8.0 group, with 30-day mortality rates of 19.1% and 38.2% (P < 0.001) and 360-day mortality rates of 31.1% and 55.6% (P < 0.001). Multivariate Cox regression models showed an increased risk of death for 30-day mortality (HR = 1.219, 95% CI 1.095-1.357; P < 0.001) and 360-day mortality (HR = 1.263, 95% CI 1.159-1.376; P < 0.001) in the high BAR group compared to the low BAR group. For the 30-day outcome, the area under the curve (AUC) was 0.661 for BAR and 0.668 for 360-day BAR. In the subgroup analysis, BAR remained an isolated risk factor for patient death. As a clinically inexpensive and readily available parameter, BAR can be a valuable forecaster of prognosis in patients with sepsis in the intensive care unit.
探讨血尿素氮（BUN）与血清白蛋白比值（BAR）在重症监护病房（ICU）脓毒症患者中的能力，以预测短期和长期死亡的预后。数据来自市场重症监护医疗信息 IV（MIMIC-IV v2.0）数据库中 SEPSIS-3 定义的脓毒症患者。主要结局为 30 天死亡率，次要结局为 360 天死亡率。绘制 Kaplan-Meier（KM）生存曲线以描述不同亚组中 BAR 死亡率的差异，并进行曲线下面积（AUC）分析以比较序贯器官衰竭评估（SOFA）、BAR、BUN 和白蛋白的预测价值。采用多变量 Cox 回归模型和亚组分析确定 BAR 与 30 天死亡率和 360 天死亡率的相关性。共纳入 7656 例符合条件的患者，中位 BAR 值为 8.0mg/g，其中≤8.0 组 3837 例，BAR＞8.0 组 3819 例，30 天死亡率分别为 19.1%和 38.2%（P＜0.001），360 天死亡率分别为 31.1%和 55.6%（P＜0.001）。多变量 Cox 回归模型显示，BAR 高组 30 天死亡率（HR=1.219，95%CI 1.095-1.357；P＜0.001）和 360 天死亡率（HR=1.263，95%CI 1.159-1.376；P＜0.001）的死亡风险均增加。对于 30 天结局，BAR 的曲线下面积（AUC）为 0.661，360 天 BAR 的 AUC 为 0.668。在亚组分析中，BAR 仍然是患者死亡的独立危险因素。作为一种临床上廉价且易于获得的参数，BAR 可以成为 ICU 脓毒症患者预后的有价值预测因子。
