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BUN-to-ALB ratio as an effective predictor of 30 day mortality in ADHF patients in eastern China
Xin Huang1,2,3,4, Chao Wang1,2,3,4, Shiming He1,2,3,4
1Jiangxi Medical College, Nanchang University, Nanchang, China.
Insights
The blood urea nitrogen-to-albumin ratio (BAR) effectively predicts short-term mortality in acute decompensated heart failure (ADHF) patients. A BAR threshold of 0.33 indicates a significantly higher risk of 30-day mortality.
Area of Science:
- Cardiology
- Biomarkers
- Prognostic Indicators
Background:
- Heart failure (HF) prognosis assessment is crucial.
- The blood urea nitrogen-to-albumin ratio (BAR) is a potential prognostic indicator for HF.
- The prognostic value of BAR in Chinese patients with acute decompensated HF (ADHF) requires further investigation.
Purpose of the Study:
- To evaluate the prognostic value of BAR for short-term mortality in ADHF patients.
- To determine the optimal BAR threshold for predicting 30-day mortality in ADHF.
- To explore the relationship between BAR and prognosis in a Chinese population.
Main Methods:
- Analysis of 1421 ADHF patients admitted between 2019-2022.
- Utilized Cox regression models to assess BAR's role in short-term prognosis.
- Employed restricted cubic spline and ROC curve analyses to determine nonlinear relationships, thresholds, and predictive accuracy for 30-day mortality.
Main Results:
- A high BAR (≥0.33) was significantly associated with increased 30-day mortality risk (HR: 3.25).
- The mortality rate was substantially higher in the high-BAR group (12.46%) compared to the low-BAR group (1.26%).
- Restricted cubic spline analysis revealed a nonlinear association (P<0.001) with a threshold between 0.3-0.5. ROC analysis yielded an AUC of 0.84 for predicting 30-day mortality.
Conclusions:
- BAR is an effective predictor of short-term prognosis in ADHF patients.
- An optimal BAR threshold of 0.33 was identified for predicting 30-day mortality.
- Findings are based on clinical data from the Jiangxi population, highlighting BAR's utility in this demographic.
Aims:
The blood urea nitrogen-to-albumin ratio (BAR) is considered a potential indicator for assessing the poor prognosis of heart failure (HF). However, its prognostic value for Chinese patients with acute decompensated HF (ADHF) remains unclear.
Methods:
This study included ADHF patients who met the study criteria and were admitted to Jiangxi Provincial People's Hospital from 2019 to 2022. We first employed univariate and multivariate Cox regression models to determine the role of BAR in evaluating the short-term prognosis of ADHF patients. Subsequently, we used restricted cubic spline regression to explore the nonlinear relationship and potential threshold between BAR and prognosis. Receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive accuracy of BAR for 30 day mortality and identify relevant threshold points.
Results:
A total of 1421 patients were included in the analysis, and the population was divided into two groups based on the optimal threshold for BAR (0.33) determined by ROC curve analysis. During the median 30 day follow-up period, the mortality rates in the high-BAR and low-BAR groups were 12.46% and 1.26%, respectively. Multivariable Cox regression analysis indicated that a high BAR was associated with an increased 30 day mortality risk in ADHF patients [hazard ratio (HR): 3.25, 95% confidence interval (CI): 1.28-8.30], particularly among those with concomitant cerebral infarction (HR: 19.12, 95% CI: 2.67-136.67). The five sensitivity analyses completed were consistent with the results of the main analysis. Furthermore, restricted cubic spline analysis revealed a nonlinear association between BAR and short-term mortality in ADHF patients (P for nonlinearity: <0.001), with a potential threshold effect observed when BAR was between 0.3 and 0.5. ROC curve analysis determined that the predictive efficiency of BAR for short-term mortality in ADHF patients was ~84%, with an area under the ROC curve (AUC) of 0.84.
Conclusions:
This study found that BAR can serve as an effective predictor of short-term prognosis in ADHF patients based on clinical data from the Jiangxi population, with an optimal predictive threshold calculated at 0.33.
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