Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AKI | Acute kidney injury |
ICU | Intensive care unit |
GCS | Glasgow Coma Scale |
APACHE II | Acute Physiology and Chronic Health Evaluation |
RRT | Renal replacement therapy |
MV | Mechanical ventilation |
LOS | Length of stay |
BUN | Blood urea nitrogen |
LDH | Lactic dehydrogenase |
Crp | C-reactive protein |
APTT | Activated partial thromboplastin time |
INR | International normalized ratio |
BAR | BUN/albumin |
References
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Characteristic | All Patients (n = 154) | Survivors (n = 86) | Non-Survivors (n = 68) | p-Value |
---|---|---|---|---|
Clinical parameter, (mean ± SD), n (%) | ||||
Age (years) | 76.76 ± 7.28 | 76.66 ± 6.92 | 76.88 ± 7.77 | 0.853 |
Gender (male) | 77 (50%) | 41 (47.67%) | 36 (52.94%) | 0.516 |
Comorbidity, n (%) | ||||
Diabetes mellitus | 57 (37.01%) | 36 (41.86%) | 21 (30.88%) | 0.161 |
Hypertension | 76 (49.35%) | 44 (51.16%) | 32 (47.06%) | 0.613 |
Heart disease | 65 (42.21%) | 39 (45.35%) | 26 (38.24%) | 0.375 |
Lung disease | 33 (21.43%) | 24 (27.91%) | 9 (13.24%) | 0.028 |
Liver disease | 3 (1.95%) | 1 (1.16%) | 2 (2.94%) | 0.428 |
Neurological diseases | 34 (22.08%) | 16 (18.6%) | 18 (26.47%) | 0.243 |
Malignancy | 14 (9.09%) | 7 (8.14%) | 7 (10.29%) | 0.644 |
Other | 5 (3.25%) | 3 (3.49%) | 2 (2.94%) | 0.849 |
Clinical scores, (mean ± SD) | ||||
GCS | 11.87 ± 3.78 | 13.83 ± 1.88 | 9.4 ± 4.13 | <0.001 |
APACHE II | 20.79 ± 8.73 | 17.12 ± 6.51 | 25.43 ± 9.02 | <0.001 |
Treatments/examination, n (%) | ||||
Oliguria (first day) | 69 (44.81%) | 26 (30.23%) | 43 (63.24%) | <0.001 |
Diuretic use | 71 (46.1%) | 33 (38.37%) | 38 (55.88%) | 0.030 |
RRT used [n (%)] | 24 (15.58%) | 5 (5.81%) | 19 (27.94%) | <0.001 |
Vasopressor requirement | 60 (38.96%) | 3 (3.49%) | 57 (83.82%) | <0.001 |
Sepsis | 56 (36.36%) | 17 (19.77%) | 39 (57.35%) | <0.001 |
Mechanical ventilation | 74 (48.05%) | 7 (8.14%) | 67 (98.53%) | <0.001 |
Treatments/examination, (mean ± SD) | ||||
ICU LOS (day) | 12.71 ± 14.79 | 9.44 ± 10.62 | 16.85 ± 18.04 | 0.092 |
Hospital LOS (day) | 16.9 ± 16.14 | 15.34 ± 13.5 | 18.88 ± 18.88 | 0.940 |
Laboratory parameters, (mean ± SD) | ||||
WBC | 15.8 ± 8.86 | 15.72 ± 9.67 | 15.9 ± 7.79 | 0.898 |
Hemoglobin (g/L) | 11.92 ± 10.61 | 10.95 ± 2.48 | 13.13 ± 15.7 | 0.497 |
Platelet | 257.51 ± 124.58 | 261.37 ± 123.25 | 252.63 ± 127 | 0.667 |
RDW-SD | 51.73 ± 8.95 | 51.07 ± 9.11 | 52.57 ± 8.73 | 0.233 |
RDW-CV | 16.81 ± 3.01 | 16.68 ± 2.98 | 16.97 ± 3.05 | 0.637 |
BUN (mg/dL) | 57.38 ± 43.5 | 53.08 ± 48.17 | 62.82 ± 36.37 | 0.013 |
Creatinine (umol/L) | 2.25 ± 1.35 | 2.08 ± 0.93 | 2.46 ± 1.73 | 0.154 |
Glucose (md/dL) | 177.86 ± 86.65 | 174.23 ± 84.92 | 182.46 ± 89.2 | 0.560 |
Sodium (mmol/L) | 138.69 ± 7.29 | 137.86 ± 5.98 | 139.75 ± 8.6 | 0.126 |
Potassium (mmol/L) | 4.67 ± 0.91 | 4.75 ± 0.93 | 4.58 ± 0.9 | 0.267 |
Magnesium (mmol/L) | 1.94 ± 0.41 | 1.89 ± 0.39 | 2.02 ± 0.42 | 0.072 |
Phosphate (mmol/L) | 4.09 ± 1.88 | 3.65 ± 1.2 | 4.71 ± 2.45 | 0.010 |
LDH | 452.46 ± 574.04 | 419.29 ± 670.24 | 494.41 ± 423.52 | 0.001 |
Albumin (g/dL) | 31.54 ± 6.11 | 32.93 ± 5.81 | 29.77 ± 6.07 | 0.001 |
C-Reactive protein (mg/dL) | 97.13 ± 81.12 | 83.75 ± 75.61 | 114.05 ± 85.17 | 0.004 |
APTT | 30.39 ± 12.31 | 29.35 ± 12.56 | 31.69 ± 11.95 | 0.025 |
INR | 1.45 ± 0.65 | 1.39 ± 0.55 | 1.54 ± 0.76 | 0.007 |
Lactate (mg/dL) | 2.8 ± 2.24 | 2.43 ± 1.8 | 3.26 ± 2.63 | 0.060 |
Bicarbonate (mmol/L) | 21.36 ± 12.23 | 21.01 ± 4.34 | 21.81 ± 17.81 | 0.720 |
Bun/albumin | 1.93 ± 1.45 | 1.68 ± 1.44 | 2.25 ± 1.42 | 0.015 |
AUC | SE | %95 CI (Lower–Upper) | Cut-Off | Sensitivity | Specificity | p | |
---|---|---|---|---|---|---|---|
BUN | 0.617 | 0.047 | 0.525–0.708 | 48.4 | 0.6029 | 0.5930 | 0.013 |
Albumin | 0.651 | 0.044 | 0.564–0.738 | 31.5 | 0.6047 | 0.6029 | 0.001 |
Bun/albumin | 0.655 | 0.045 | 0.567–0.743 | 1.507 | 0.6176 | 0.6163 | 0.001 |
Characteristics | BAR < 1.507 (n = 79) | BAR ≥ 1.507 (n = 75) | p Value |
---|---|---|---|
Clinical parameters, (mean ± SD), n (%) | |||
Age (years) | 76.32 ± 6.57 | 77.21 ± 7.97 | 0.566 |
Gender (male) | 41 (52.56%) | 36 (47.37%) | 0.872 |
Comorbidity, n (%) | |||
Diabetes mellitus | 30 (38.46%) | 27 (35.53%) | 0.357 |
Hypertension | 45 (57.69%) | 31 (40.79%) | 0.004 |
Heart disease | 29 (37.18%) | 36 (47.37%) | 0.444 |
Lung disease | 18 (23.08%) | 15 (19.74%) | 0.978 |
Liver disease | 1 (1.28%) | 2 (2.63%) | 0.530 |
Neurological diseases | 14 (17.95%) | 20 (26.32%) | 0.181 |
Malignancy | 6 (7.69%) | 8 (10.53%) | 0.221 |
Other | 3 (3.85%) | 2 (2.63%) | 0.692 |
Clinical scores, (mean ± SD) | |||
GCS | 12.05 ± 3.96 | 11.68 ± 3.6 | 0.157 |
APACHE 2 | 18.49 ± 7.9 | 23.14 ± 8.97 | <0.001 |
Treatments/examination, n (%) | |||
Oliguria (first day) | 29 (37.18%) | 40 (52.63%) | 0.006 |
Diuretic use | 35 (44.87%) | 36 (47.37%) | 0.646 |
RRT used | 8 (10.26%) | 16 (21.05%) | 0.005 |
Vasopressor requirement | 24 (30.77%) | 36 (47.37%) | 0.010 |
Sepsis | 26 (33.33%) | 30 (39.47%) | 0.024 |
Mechanical ventilation | 31 (39.74%) | 43 (56.58%) | 0.025 |
Treatments/examination, (mean ± SD) | |||
ICU LOS (day) | 12.67 ± 14.94 | 12.76 ± 14.74 | 0.533 |
Hospital LOS (day) | 17.38 ± 16.29 | 16.41 ± 16.07 | 0.775 |
Laboratory parameters, (mean ± SD) | |||
WBC | 15.47 ± 8.96 | 16.14 ± 8.81 | 0.765 |
Hemoglobin (g/L) | 11.33 ± 2.37 | 12.52 ± 14.94 | 0.684 |
Platelet | 259.92 ± 122.68 | 255.04 ± 127.27 | 0.714 |
RDW-SD | 50.03 ± 7.37 | 53.47 ± 10.08 | 0.005 |
RDW-CV | 16.19 ± 2.37 | 17.44 ± 3.44 | 0.002 |
BUN (mg/dL) | 35.17 ± 8.33 | 80.19 ± 52.42 | <0.001 |
Creatinine (umol/L) | 1.72 ± 0.57 | 2.8 ± 1.67 | <0.001 |
Glucose (md/dL) | 180.42 ± 86.78 | 175.24 ± 87.01 | 0.161 |
Sodium (mmol/L) | 138.69 ± 6.67 | 138.7 ± 7.92 | 0.471 |
Potassium (mmol/l) | 4.46 ± 0.87 | 4.9 ± 0.91 | 0.024 |
Magnesium (mmol/L) | 1.86 ± 0.33 | 2.03 ± 0.46 | 0.004 |
Phosphate (mmol/L) | 3.72 ± 1.77 | 4.45 ± 1.94 | 0.020 |
LDH | 454.62 ± 655.02 | 450.25 ± 481.37 | 0.939 |
Albumin (g/dL) | 33.29 ± 5.32 | 29.73 ± 6.38 | <0.001 |
C-Reactive protein (mg/dL) | 81.98 ± 63.83 | 112.67 ± 93.58 | 0.001 |
APTT | 28.44 ± 6.78 | 32.38 ± 15.94 | 0.039 |
INR | 1.36 ± 0.46 | 1.56 ± 0.79 | 0.036 |
Lactate (mg/dL) | 2.83 ± 2.27 | 2.76 ± 2.22 | 0.505 |
Bicarbonate (mmol/L) | 21.37 ± 5.23 | 21.36 ± 16.64 | 0.723 |
MORTALITY | ||||
---|---|---|---|---|
Survival | Ex | p | ||
n (%) | n (%) | |||
BUN | ≥48.4 | 35 (40.7%) | 41 (60.29%) | 0.016 |
Albumin | ≥31.5 | 52 (60.47%) | 27 (39.71%) | 0.010 |
Bun/albumin | ≥1.507 | 33 (38.37%) | 42 (61.76%) | 0.004 |
Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|
RR (95%CI) | p | RR (95%CI) | p | R2 | |
BUN < 48.4 vs. BUN ≥ 48.4 | 2.213 (1.156–4.234) | 0.016 | - | - | 0.898 |
Albumin ≥ 31.5 vs. albumin < 31.5 | 2.322 (1.212–4.450) | 0.011 | - | - | |
Bun/albumin < 1.507 vs. Bun/albumin ≥ 1.507 | 2.594 (1.349–4.991) | 0.004 | 3.944 (1.483–23.790) | 0.023 | |
Lung disease, yes vs. none | 2.538 (1.091–5.917) | 0.031 | - | - | |
Oliguria (first day), none vs. yes | 3.969 (2.002–7.791) | <0.001 | - | - | |
Diuretic use, none vs. yes | 2.034 (1.066–3.883) | 0.031 | - | - | |
RRT used [n (%)], none vs. yes | 6.282 (2.205–17.898) | 0.001 | - | - | |
Vasopressor requirement none, vs. yes | 143.364 (38.283–536.871) | <0.001 | 21.067 (3.287–135.009) | 0.001 | |
Sepsis, none vs. yes | 5.458 (2.668–11.169) | <0.001 | - | - | |
Mechanical ventilation, none vs. yes | 75.614 (9.072–630.221) | <0.001 | 37.672 (25.595–399.298) | <0.001 |
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Share and Cite
Bayrakçı, S.; Eygi, E. Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study. Medicina 2025, 61, 1233. https://doi.org/10.3390/medicina61071233
Bayrakçı S, Eygi E. Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study. Medicina. 2025; 61(7):1233. https://doi.org/10.3390/medicina61071233
Chicago/Turabian StyleBayrakçı, Sinem, and Elif Eygi. 2025. "Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study" Medicina 61, no. 7: 1233. https://doi.org/10.3390/medicina61071233
APA StyleBayrakçı, S., & Eygi, E. (2025). Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study. Medicina, 61(7), 1233. https://doi.org/10.3390/medicina61071233