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Background <p>Sepsis remains a leading cause of mortality in intensive care unit (ICU) patients, with mortality rates up to 30%. While the Blood Urea Nitrogen (BUN) to Albumin ratio has been associated with outcomes in various conditions, the dose–response relationship between this ratio and mortality in sepsis patients remains unclear.</p> Methods <p>This retrospective cohort study analyzed 9,783 sepsis patients from the eICU Collaborative Research Database. The relationship between BUN/Albumin ratio and 28-day ICU mortality was examined using multivariate logistic regression and threshold effect analysis. Models were adjusted for demographics, clinical parameters, comorbidities, and laboratory values. Threshold effect analysis was performed using two-piecewise linear regression.</p> Results <p>A non-linear relationship was identified between the BUN/Albumin ratio and 28-day ICU mortality, with a threshold at 20.91&#xa0;mg/g (95% CI 17.19–26.90). Below this threshold, each unit difference in the ratio was associated with higher mortality odds (OR: 1.06, 95% CI 1.04–1.08, <i>P</i> &lt; 0.0001). Above the threshold, the association persisted but is markedly attenuated (OR: 1.01, 95% CI 1.00–1.02). This relationship remained robust after adjusting for potential confounders and in sensitivity analyses.</p> Conclusions <p>A nonlinear association was observed between the BUN/Albumin ratio and 28-day ICU mortality among patients with sepsis, with an inflection point established at 20.91&#xa0;mg/g. This readily accessible parameter has the potential to aid in early risk stratification within the ICU setting. Additional research is warranted to validate these findings.</p>

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The association between blood urea nitrogen to albumin ratio and 28-day ICU mortality in sepsis patients: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Meiting Wu,
  • Huijun Sun,
  • Huiying Lv,
  • Aiyong Zhu

摘要

Background

Sepsis remains a leading cause of mortality in intensive care unit (ICU) patients, with mortality rates up to 30%. While the Blood Urea Nitrogen (BUN) to Albumin ratio has been associated with outcomes in various conditions, the dose–response relationship between this ratio and mortality in sepsis patients remains unclear.

Methods

This retrospective cohort study analyzed 9,783 sepsis patients from the eICU Collaborative Research Database. The relationship between BUN/Albumin ratio and 28-day ICU mortality was examined using multivariate logistic regression and threshold effect analysis. Models were adjusted for demographics, clinical parameters, comorbidities, and laboratory values. Threshold effect analysis was performed using two-piecewise linear regression.

Results

A non-linear relationship was identified between the BUN/Albumin ratio and 28-day ICU mortality, with a threshold at 20.91 mg/g (95% CI 17.19–26.90). Below this threshold, each unit difference in the ratio was associated with higher mortality odds (OR: 1.06, 95% CI 1.04–1.08, P < 0.0001). Above the threshold, the association persisted but is markedly attenuated (OR: 1.01, 95% CI 1.00–1.02). This relationship remained robust after adjusting for potential confounders and in sensitivity analyses.

Conclusions

A nonlinear association was observed between the BUN/Albumin ratio and 28-day ICU mortality among patients with sepsis, with an inflection point established at 20.91 mg/g. This readily accessible parameter has the potential to aid in early risk stratification within the ICU setting. Additional research is warranted to validate these findings.