Yang Jingxiang, Wang Jiuyi, Wang Kai
Department of Pulmonary and Critical Care Medicine, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
Department of General Medicine, The Affiliated Yongchuan Hospital of Chongqing Medical University, No.439 Xuanhua Road, Chongqing, 402160, China.
Sci Rep. 2025 Aug 15;15(1):29971. doi: 10.1038/s41598-025-16383-w.
New studies have revealed an association between chronic heart failure, the severity of septic shock, and the blood urea nitrogen to albumin ratio (BAR). Nevertheless, its role in congestive heart failure patients admitted to the intensive care unit remains unclear. This study aimed to investigate the association between BAR and mortality among these patients. The present study analyzed data from the MIMIC-IV (version 2.2) database, targeting patients with congestive heart failure. The study outcome was all-cause mortality within the first year after discharge. Patients were categorized into three groups-T1, T2, and T3-based on tertiles of BAR levels. To explore the relationship between BAR and mortality, Kaplan-Meier survival curves and multivariate Cox proportional hazards models, adjusted for potential confounders, were employed. Additionally, a dose-response relationship between BAR and mortality risk was evaluated using a restricted cubic spline model and threshold effect analysis. Subgroup analyses were conducted across diverse populations to assess the prognostic value of BAR. Furthermore, the predictive capabilities of blood urea nitrogen, albumin, blood urea nitrogen combined with albumin, and BAR were assessed through receiver operating characteristic analysis. The cohort comprised 4506 patients diagnosed with congestive heart failure. Kaplan-Meier curves revealed that all-cause mortality was significantly elevated in patients within the higher BAR tertiles (p < 0.001). Multivariate Cox regression analysis indicated that patients in the T2 (hazard ratio (HR): 1.20, 95% confidence interval (CI): 1.06 ~ 1.36) and T3 groups (HR: 1.37, 95% CI: 1.18 ~ 1.57) had a significant increase in mortality risk relative to the T1 group (p for linear trend < 0.001). Most subgroups showed this association, with the exception of variations of levels in creatinine, blood urea nitrogen, alkaline phosphatase, and alanine aminotransferase. Notably, the BAR demonstrated superior predictive accuracy for mortality compared to blood urea nitrogen or serum albumin alone, while exhibiting comparable performance to their combined measure. Among ICU patients with congestive heart failure, an elevated BAR was associated with an increased risk of all-cause 1-year mortality, particularly in those with less impaired liver and kidney function. Therefore, BAR may be measured to comprehensively evaluate the patients' prognosis.
新的研究揭示了慢性心力衰竭、感染性休克的严重程度与血尿素氮与白蛋白比值（BAR）之间的关联。然而，其在入住重症监护病房的充血性心力衰竭患者中的作用仍不明确。本研究旨在调查这些患者中BAR与死亡率之间的关联。本研究分析了MIMIC-IV（版本2.2）数据库中的数据，目标是充血性心力衰竭患者。研究结果是出院后第一年内的全因死亡率。根据BAR水平的三分位数将患者分为三组——T1、T2和T3。为了探究BAR与死亡率之间的关系，采用了Kaplan-Meier生存曲线和针对潜在混杂因素进行调整的多变量Cox比例风险模型。此外，使用受限立方样条模型和阈值效应分析评估了BAR与死亡风险之间的剂量反应关系。在不同人群中进行了亚组分析，以评估BAR的预后价值。此外，通过受试者工作特征分析评估了血尿素氮、白蛋白、血尿素氮与白蛋白联合以及BAR的预测能力。该队列包括4506名被诊断为充血性心力衰竭的患者。Kaplan-Meier曲线显示，BAR三分位数较高的患者全因死亡率显著升高（p < 0.001）。多变量Cox回归分析表明，相对于T1组，T2组（风险比（HR）：1.20，95%置信区间（CI）：1.06 ~ 1.36）和T3组（HR：1.37，95% CI：1.18 ~ 1.57）的死亡风险显著增加（线性趋势p < 0.001）。除了肌酐、血尿素氮、碱性磷酸酶和丙氨酸转氨酶水平的变化外，大多数亚组都显示出这种关联。值得注意的是，与单独的血尿素氮或血清白蛋白相比，BAR对死亡率的预测准确性更高，而与它们的联合测量表现相当。在患有充血性心力衰竭的ICU患者中，BAR升高与全因1年死亡率风险增加相关，尤其是在肝肾功能损害较轻的患者中。因此，可以测量BAR以全面评估患者的预后。
