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Prognostic Value of the Blood Urea Nitrogen-to-Albumin Ratio for ICU Mortality in Cardiogenic Shock Patients:

Hu Liu, Yan-Bo Zhao, Can Wang

    Clinical Laboratory
    |June 15, 2026
    PubMed

    Insights

    Elevated blood urea nitrogen-to-albumin ratio (BAR) is linked to higher mortality in cardiogenic shock (CS) patients. This simple marker can aid in early risk stratification for better patient outcomes.

    Area of Science:

    • Critical Care Medicine
    • Nephrology
    • Cardiology

    Background:

    • Cardiogenic shock (CS) presents a significant challenge due to its high mortality rate.
    • Early identification of high-risk patients is crucial for effective management.
    • The blood urea nitrogen-to-albumin ratio (BAR) is a potential indicator of renal function and nutritional status.

    Purpose of the Study:

    • To investigate the association between the BAR and 28-day mortality in patients with cardiogenic shock.
    • To evaluate the utility of BAR as a simple, early risk stratification tool for CS patients.
    • To explore potential mediating factors in the relationship between BAR and CS outcomes.

    Main Methods:

    • Analysis of data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
    • Categorization of 1,474 CS patients into BAR quartiles to assess 28-day ICU mortality.
    • Application of LASSO regression, logistic regression, Cox proportional hazards models, and restricted cubic splines.
    • Utilized Kaplan-Meier curves for survival analysis and causal mediation analysis (CMA) to explore indirect effects.

    Main Results:

    • A higher BAR was significantly associated with an increased risk of 28-day ICU mortality in CS patients.
    • Patients in the highest BAR quartile exhibited a 1.88-fold increased mortality risk (p=0.001) compared to the lowest quartile.
    • Hemoglobin levels partially mediated the effect of BAR on prognosis, accounting for 10.88% of the association.
    • The association remained consistent across subgroups, with notable interactions in race and acute kidney injury (AKI) groups.

    Conclusions:

    • Elevated BAR is a significant predictor of adverse intensive care unit (ICU) outcomes in patients with cardiogenic shock.
    • BAR serves as a valuable and simple early risk stratification marker for CS.
    • Further research into mediating factors like hemoglobin may refine risk assessment in CS.
    Abstract

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