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Background <p>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.</p> Methods <p>In all, 1441 patients with confirmed IE were included and divided into four groups according to the level of BUN and HDL: BUN&#xa0;&gt;&#xa0;5.2mmol/L and HDL&#xa0;&lt;&#xa0;0.7mmol/L (<i>n&#xa0;</i>=&#xa0;296), BUN&#xa0;&gt;&#xa0;5.2mmol/L and HDL ≥&#xa0;0.7mmol/L (<i>n&#xa0;</i>=&#xa0;364), BUN&#xa0;≤&#xa0;5.2mmol/L and HDL&#xa0;&lt;&#xa0;0.7mmol/L (<i>n&#xa0;</i>=&#xa0;327), and BUN&#xa0;≤&#xa0;5.2mmol/L and HDL&#xa0;≥&#xa0;0.7mmol/L (<i>n&#xa0;</i>=&#xa0;454). BHR was calculated as BUN/HDL. Multivariable analyses were conducted to determine the association of BHR with adverse events.</p> Results <p>The in-hospital mortality was 6.4%. Patients with BUN&#xa0;&gt;&#xa0;5.2mmol/L and HDL&#xa0;&lt;&#xa0;0.7mmol/L had a significantly higher risk of in-hospital death than those with BUN&#xa0;≤&#xa0;5.2mmol/L and HDL&#xa0;≥&#xa0;0.7mmol/L (adjusted odds ratio [aOR]&#xa0;=&#xa0;4.65, 95% confidence interval [CI]: 1.91-11.35, <i>p&#xa0;</i>=&#xa0;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, <i>p</i> = 0.01) or HDL (AUC: 0.744 vs 0.648, <i>p</i> &lt;&#xa0;0.001)&#xa0;for in-hospital mortality, and the optimal cut-off value&#xa0;was 7.4 (sensitivity, 79.3%; specificity, 60.3%).&#xa0;Furthermore, the cumulative 6-month mortality risk was significantly higher in patients with BHR&#xa0;&gt;&#xa0;7.4 than those with BHR&#xa0;≤&#xa0;7.4 (log-rank&#xa0;=&#xa0;93.4, <i>p&#xa0;</i>&lt;&#xa0;0.001). BHR&#xa0;&gt;&#xa0;7.4 was an independent risk factor for 6-month mortality in IE (adjusted hazard ratio [aHR]&#xa0;=&#xa0;3.77, 95%CI: 2.32-6.11, <i>p&#xa0;</i>&lt;&#xa0;0.001).</p> Conclusions <p>BHR offers a high predictive value for short-term mortality in IE, positioning it as a potential stratification tool for critical care triage.&#xa0;</p>

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

  • 期刊论文

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  • 发表日期：

    2025年5月30日

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  • Qi Wang,
  • Jing-wen Li,
  • Shuai-zheng Che,
  • Jie-leng Huang,
  • Mei Jiang,
  • Jun-quan Lu,
  • Di Wu,
  • Dan-qing Yu,
  • Xue‑biao Wei

摘要

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.