Association between blood urea nitrogen to albumin ratio and 28-day mortality in ICU patients with acute respiratory failure: a retrospective analysis of MIMIC-IV database.

Purpose: The effect of the blood urea nitrogen-to-albumin ratio (BAR) on 28-day mortality in intensive care unit (ICU) patients with acute respiratory failure (ARF) is unknown.

Methods: Patients diagnosed with ARF were screened and randomly divided into training and validation sets (7:3) on the basis of the ICD-9 and ICD-10 diagnosis codes in the Medical Information Mart for Intensive Care IV (v.2.2) database. The primary outcome was the 28-day mortality after ICU admission. The training set was categorized into the low- and high-BAR groups on the basis of the optimal BAR cutoff values for 28-day mortality determined via receiver operating characteristic analysis. The clinical significance of the BAR was evaluated by the areas under the curve (AUCs), decision curve analysis (DCA), Kaplan-Meier (K-M) survival curve, logistic regression analyses and subgroup analysis.

Results: In total, 2,766 patients were included. The 28-day mortality rate was 30.2%. The AUCs and 95% confidence interval (CI) for the BAR were AUC 0.644 (95%CI, 0.618 to 0.671) in training set. Multivariate logistic regression revealed that the BAR was an independent factor affecting the prognosis of ARF in both training and validation sets. K-M curves revealed a significant difference in 28-day mortality between the low- and high-BAR groups (p < 0.001). DCA showed moderate performance. No obvious interaction was found by subgroup analysis in most subgroups.

Conclusion: The present work revealed that elevated BAR was significantly associated with worse 28-day mortality in patients with any cause of ARF. It remains to be shown whether retrospective analysis of an independent cohort can confirm the high predictive value of BAR.