Huang Xin, Wang Chao, He Shiming, Jian Guoan, Jiang Kun, Lu Zihao, Sheng Guotai, Zou Yang, Xie Guobo
Jiangxi Medical College, Nanchang University, Nanchang, China.
Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
ESC Heart Fail. 2025 Apr 1. doi: 10.1002/ehf2.15289.
The blood urea nitrogen-to-albumin ratio (BAR) is considered a potential indicator for assessing the poor prognosis of heart failure (HF). However, its prognostic value for Chinese patients with acute decompensated HF (ADHF) remains unclear.
This study included ADHF patients who met the study criteria and were admitted to Jiangxi Provincial People's Hospital from 2019 to 2022. We first employed univariate and multivariate Cox regression models to determine the role of BAR in evaluating the short-term prognosis of ADHF patients. Subsequently, we used restricted cubic spline regression to explore the nonlinear relationship and potential threshold between BAR and prognosis. Receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive accuracy of BAR for 30 day mortality and identify relevant threshold points.
A total of 1421 patients were included in the analysis, and the population was divided into two groups based on the optimal threshold for BAR (0.33) determined by ROC curve analysis. During the median 30 day follow-up period, the mortality rates in the high-BAR and low-BAR groups were 12.46% and 1.26%, respectively. Multivariable Cox regression analysis indicated that a high BAR was associated with an increased 30 day mortality risk in ADHF patients [hazard ratio (HR): 3.25, 95% confidence interval (CI): 1.28-8.30], particularly among those with concomitant cerebral infarction (HR: 19.12, 95% CI: 2.67-136.67). The five sensitivity analyses completed were consistent with the results of the main analysis. Furthermore, restricted cubic spline analysis revealed a nonlinear association between BAR and short-term mortality in ADHF patients (P for nonlinearity: <0.001), with a potential threshold effect observed when BAR was between 0.3 and 0.5. ROC curve analysis determined that the predictive efficiency of BAR for short-term mortality in ADHF patients was ~84%, with an area under the ROC curve (AUC) of 0.84.
This study found that BAR can serve as an effective predictor of short-term prognosis in ADHF patients based on clinical data from the Jiangxi population, with an optimal predictive threshold calculated at 0.33.
血尿素氮与白蛋白比值（BAR）被认为是评估心力衰竭（HF）预后不良的一个潜在指标。然而，其对中国急性失代偿性心力衰竭（ADHF）患者的预后价值仍不明确。
本研究纳入了2019年至2022年期间符合研究标准并入住江西省人民医院的ADHF患者。我们首先采用单因素和多因素Cox回归模型来确定BAR在评估ADHF患者短期预后中的作用。随后，我们使用限制立方样条回归来探索BAR与预后之间的非线性关系和潜在阈值。进行受试者工作特征（ROC）曲线分析以计算BAR对30天死亡率的预测准确性并确定相关阈值点。
共有1421例患者纳入分析，根据ROC曲线分析确定的BAR最佳阈值（0.33）将人群分为两组。在30天的中位随访期内，高BAR组和低BAR组的死亡率分别为12.46%和1.26%。多因素Cox回归分析表明，高BAR与ADHF患者30天死亡风险增加相关[风险比（HR）：3.25，95%置信区间（CI）：1.28 - 8.30]，尤其是在合并脑梗死的患者中（HR：19.12，95%CI：2.67 - 136.67）。完成的五项敏感性分析结果与主要分析结果一致。此外，限制立方样条分析显示ADHF患者中BAR与短期死亡率之间存在非线性关联（非线性P值：<0.001），当BAR在0.3至0.5之间时观察到潜在阈值效应。ROC曲线分析确定BAR对ADHF患者短期死亡率的预测效率约为84%，ROC曲线下面积（AUC）为0.84。
本研究发现，基于江西人群的临床数据，BAR可作为ADHF患者短期预后的有效预测指标，计算得出的最佳预测阈值为0.33。
