血尿素氮与高密度脂蛋白胆固醇的比值：一种用于感染性心内膜炎的新型风险分层工具。

The ratio of blood urea nitrogen to high-density lipoprotein cholesterol: a novel risk-stratifying tool for infective endocarditis.

作者信息

Wang Qi, Li Jing-Wen, Che Shuai-Zheng, Huang Jie-Leng, Jiang Mei, Lu Jun-Quan, Wu Di, Yu Dan-Qing, Wei Xue-Biao

机构信息

Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.

Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Lipids Health Dis. 2025 May 30;24(1):196. doi: 10.1186/s12944-025-02595-6.

DOI:10.1186/s12944-025-02595-6

PMID:40448042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12124007/

Abstract

BACKGROUND

Increased blood urea nitrogen (BUN) and decreased high-density lipoprotein cholesterol (HDL) are common in infectious diseases. However, the prognostic significance of the BUN-to-HDL ratio (BHR) in patients with infective endocarditis (IE) is yet unknown.

METHODS

In all, 1441 patients with confirmed IE were included and divided into four groups according to the level of BUN and HDL: BUN > 5.2mmol/L and HDL < 0.7mmol/L (n = 296), BUN > 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 364), BUN ≤ 5.2mmol/L and HDL < 0.7mmol/L (n = 327), and BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 454). BHR was calculated as BUN/HDL. Multivariable analyses were conducted to determine the association of BHR with adverse events.

RESULTS

The in-hospital mortality was 6.4%. Patients with BUN > 5.2mmol/L and HDL < 0.7mmol/L had a significantly higher risk of in-hospital death than those with BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (adjusted odds ratio [aOR] = 4.65, 95% confidence interval [CI]: 1.91-11.35, p = 0.001). The decision curve analysis indicated that the combination of BUN and HDL had higher net benefit than either alone. BHR presented a higher predictive value than BUN (AUC: 0.744 vs 0.693, p = 0.01) or HDL (AUC: 0.744 vs 0.648, p < 0.001) for in-hospital mortality, and the optimal cut-off value was 7.4 (sensitivity, 79.3%; specificity, 60.3%). Furthermore, the cumulative 6-month mortality risk was significantly higher in patients with BHR > 7.4 than those with BHR ≤ 7.4 (log-rank = 93.4, p < 0.001). BHR > 7.4 was an independent risk factor for 6-month mortality in IE (adjusted hazard ratio [aHR] = 3.77, 95%CI: 2.32-6.11, p < 0.001).

CONCLUSIONS

BHR offers a high predictive value for short-term mortality in IE, positioning it as a potential stratification tool for critical care triage.

摘要

背景

传染病患者中常见血尿素氮（BUN）升高和高密度脂蛋白胆固醇（HDL）降低。然而，BUN与HDL比值（BHR）在感染性心内膜炎（IE）患者中的预后意义尚不清楚。

方法

共纳入1441例确诊为IE的患者，并根据BUN和HDL水平分为四组：BUN>5.2mmol/L且HDL<0.7mmol/L（n=296），BUN>5.2mmol/L且HDL≥0.7mmol/L（n=364），BUN≤5.2mmol/L且HDL<0.7mmol/L（n=327），以及BUN≤5.2mmol/L且HDL≥0.7mmol/L（n=454）。BHR计算为BUN/HDL。进行多变量分析以确定BHR与不良事件的关联。

结果

住院死亡率为6.4%。BUN>5.2mmol/L且HDL<0.7mmol/L的患者比BUN≤5.2mmol/L且HDL≥0.7mmol/L的患者住院死亡风险显著更高（调整后的优势比[aOR]=4.65，95%置信区间[CI]：1.91-11.35，p=0.001）。决策曲线分析表明，BUN和HDL的联合使用比单独使用具有更高的净效益。BHR对住院死亡率的预测价值高于BUN（曲线下面积[AUC]：0.744对0.693，p=0.01）或HDL（AUC：0.744对0.648，p<0.001），最佳截断值为7.4（敏感性为79.3%；特异性为60.3%）。此外，BHR>7.4的患者6个月累积死亡风险显著高于BHR≤7.4的患者（对数秩=93.4，p<0.001）。BHR>7.4是IE患者6个月死亡率的独立危险因素（调整后的风险比[aHR]=3.77，95%CI：2.32-6.11，p<0.001）。