2型糖尿病合并缺血性卒中患者血尿素氮与血清白蛋白比值与院内死亡率的关系
Relationship between the blood urea nitrogen to serum albumin ratio and in-hospital mortality in patients with type 2 diabetes mellitus complicated with ischemic stroke.
作者信息
Wang Peng, Jiang Shuyuan, Hua Yunqi, Xie Wei, Shao Guo, Zhu Hongwei
机构信息
The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia, Baotou, China.
School of Pharmacy, Baotou Medical College, Baotou, China.
出版信息
PLoS One. 2025 Sep 10;20(9):e0330168. doi: 10.1371/journal.pone.0330168. eCollection 2025.
BACKGROUND
Type 2 diabetes mellitus (T2DM) complicated with ischemic stroke is a major challenge to global public health and is related to poor prognosis. However, the role of blood urea nitrogen(BUN)to serum albumin ratio (BAR) in predicting in-hospital mortality of T2DM patients with ischemic stroke has not been fully explored. This study was carried out to investigate the relationship between BAR level and in-hospital mortality of T2DM patients with ischemic stroke.
METHODS
The MIMIC-IV database was searched for data on T2DM patients with ischemic stroke. The primary outcome was in-hospital mortality. The BAR was calculated as follows: BUN (mg/dl)/ serum albumin (g/dl). Logistic regression was employed to investigate the relationship between BAR and in-hospital mortality of T2DM patients with ischemic stroke. The restricted cubic spline (RCS) was leveraged to examine the dose-response relationship of BAR with the outcome. The receiver operating characteristic (ROC) curve was utilized to measure the ability of BAR to predict the outcome. In addition, the decision curve analysis (DCA) was employed to explore the value of BAR in clinical practice. The consistency and robustness of the research results were assessed by subgroup analysis and the presence of interactions using a likelihood ratio test.
RESULTS
Finally, 1136 patients were included for evaluation in this study. As BAR levels increased, the in-hospital mortality of T2DM patients with ischemic stroke also increased (OR:1.06; 95% CI:1.01-1.11; P < 0.01). The RCS analysis suggested that there was a linear relationship between BAR and in-hospital mortality of T2DM patients with ischemic stroke (p = 0.276). The ROC curve indicated that BAR was superior to BUN, Sepsis-related Organ Failure Assessment (SOFA), and Glasgow Coma Scale (GCS) in predicting the in-hospital mortality of T2DM patients with ischemic stroke. The DCA curve indicated that the net benefit of BAR was better than BUN, SOFA, and GCS. Subgroup analysis showed that there was no interaction between BAR and each subgroup (all p-value > 0.05).
CONCLUSION
The in-hospital mortality of T2DM patients with ischemic stroke increased with elevated BAR levels.
背景
2型糖尿病（T2DM）合并缺血性卒中是全球公共卫生面临的重大挑战，且与预后不良相关。然而，血尿素氮（BUN）与血清白蛋白比值（BAR）在预测T2DM合并缺血性卒中患者院内死亡率方面的作用尚未得到充分研究。本研究旨在探讨BAR水平与T2DM合并缺血性卒中患者院内死亡率之间的关系。
方法
在MIMIC-IV数据库中检索T2DM合并缺血性卒中患者的数据。主要结局是院内死亡率。BAR的计算方法如下：BUN（mg/dl）/血清白蛋白（g/dl）。采用逻辑回归分析探讨BAR与T2DM合并缺血性卒中患者院内死亡率之间的关系。利用限制立方样条（RCS）来检验BAR与结局之间的剂量反应关系。采用受试者工作特征（ROC）曲线来衡量BAR预测结局的能力。此外，采用决策曲线分析（DCA）来探讨BAR在临床实践中的价值。通过亚组分析和使用似然比检验的交互作用存在情况来评估研究结果的一致性和稳健性。
结果
最终，1136例患者纳入本研究进行评估。随着BAR水平升高，T2DM合并缺血性卒中患者的院内死亡率也升高（OR：1.06；95%CI：1.01-1.11；P＜0.01）。RCS分析表明，BAR与T2DM合并缺血性卒中患者的院内死亡率之间存在线性关系（p = 0.276）。ROC曲线表明，在预测T2DM合并缺血性卒中患者的院内死亡率方面，BAR优于BUN、脓毒症相关器官功能衰竭评估（SOFA）和格拉斯哥昏迷量表（GCS）。DCA曲线表明，BAR的净效益优于BUN、SOFA和GCS。亚组分析表明，BAR与各亚组之间不存在交互作用（所有p值＞0.05）。
结论
T2DM合并缺血性卒中患者的院内死亡率随BAR水平升高而增加。
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