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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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 (<i>p</i> &lt; 0.001). DCA showed moderate performance. No obvious interaction was found by subgroup analysis in most subgroups.</p> Conclusion <p>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.</p>

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Association between blood urea nitrogen to albumin ratio and 28-day mortality in ICU patients with acute respiratory failure: a retrospective analysis of MIMIC-IV database

  • 期刊论文

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  • 发表日期：

    2025年7月6日

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  • Zhen Li,
  • Jun Xie,
  • Qian He,
  • Chong Li

摘要

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.