Li Zhen, Xie Jun, He Qian, Li Chong
Department of Pediatrics, Xinqiao Street Health Service Center, Xinbei District, Changzhou, China.
Department of Respiration, First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Ju-qian Road No.185, Changzhou, 213003, China.
BMC Med Inform Decis Mak. 2025 Jul 6;25(1):253. doi: 10.1186/s12911-025-03100-w.
The effect of the blood urea nitrogen-to-albumin ratio (BAR) on 28-day mortality in intensive care unit (ICU) patients with acute respiratory failure (ARF) is unknown.
Patients diagnosed with ARF were screened and randomly divided into training and validation sets (7:3) on the basis of the ICD-9 and ICD-10 diagnosis codes in the Medical Information Mart for Intensive Care IV (v.2.2) database. The primary outcome was the 28-day mortality after ICU admission. The training set was categorized into the low- and high-BAR groups on the basis of the optimal BAR cutoff values for 28-day mortality determined via receiver operating characteristic analysis. The clinical significance of the BAR was evaluated by the areas under the curve (AUCs), decision curve analysis (DCA), Kaplan-Meier (K-M) survival curve, logistic regression analyses and subgroup analysis.
In total, 2,766 patients were included. The 28-day mortality rate was 30.2%. The AUCs and 95% confidence interval (CI) for the BAR were AUC 0.644 (95%CI, 0.618 to 0.671) in training set. Multivariate logistic regression revealed that the BAR was an independent factor affecting the prognosis of ARF in both training and validation sets. K-M curves revealed a significant difference in 28-day mortality between the low- and high-BAR groups (p < 0.001). DCA showed moderate performance. No obvious interaction was found by subgroup analysis in most subgroups.
The present work revealed that elevated BAR was significantly associated with worse 28-day mortality in patients with any cause of ARF. It remains to be shown whether retrospective analysis of an independent cohort can confirm the high predictive value of BAR.
血尿素氮与白蛋白比值（BAR）对急性呼吸衰竭（ARF）重症监护病房（ICU）患者28天死亡率的影响尚不清楚。
根据重症监护医学信息集市IV（v.2.2）数据库中的ICD - 9和ICD - 10诊断编码，对诊断为ARF的患者进行筛选，并随机分为训练集和验证集（7:3）。主要结局是ICU入院后28天死亡率。根据通过受试者工作特征分析确定的28天死亡率的最佳BAR临界值，将训练集分为低BAR组和高BAR组。通过曲线下面积（AUC）、决策曲线分析（DCA）、Kaplan - Meier（K - M）生存曲线、逻辑回归分析和亚组分析评估BAR的临床意义。
共纳入2766例患者。28天死亡率为30.2%。训练集中BAR的AUC及95%置信区间（CI）为AUC 0.644（95%CI，0.618至0.671）。多因素逻辑回归显示，BAR是训练集和验证集中影响ARF预后的独立因素。K - M曲线显示低BAR组和高BAR组28天死亡率存在显著差异（p < 0.001）。DCA显示出中等性能。亚组分析在大多数亚组中未发现明显的相互作用。
本研究表明，BAR升高与任何原因引起的ARF患者28天死亡率较差显著相关。独立队列的回顾性分析是否能证实BAR的高预测价值仍有待观察。
