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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.

The relationship between blood urea nitrogen to albumin ratio (BAR) and the prognosis of patients with tuberculosis (TB) complicated by sepsis remains unclear. This study aimed to explore the association between BAR and overall patient prognosis. This was a retrospective cohort study of patients with TB complicated by sepsis who were admitted to the intensive care unit (ICU) of the Public Health Clinical Center of Chengdu between January 2019 and February 2023. The relationship between BAR values and prognosis in these patients was investigated using multivariate Cox regression, stratified analysis with interaction, restricted cubic spline (RCS), and threshold effect analysis. Sensitivity analyses were conducted to assess the robustness of the results. Our study included 537 TB patients complicated by sepsis admitted in the ICU, with a median age of 63.0 (48.0, 72.0) years; 76.7% of whom were men. The multivariate-restricted cubic spline analysis showed a non-linear association between BAR and patient prognosis. In the threshold analysis, we found that TB patients complicated by sepsis and a BAR < 7.916 mg/g had an adjusted hazard ratio (HR) for prognosis of 1.163 (95% CI 1.038–1.303; P  = 0.009). However, when the BAR was ≥ 7.916 mg/g, there was no significant increase in the risk of death. The results of the sensitivity analysis were stable.

To date, good experimental animal models of renal anemia are not available. Therefore, the purpose of this study was to establish a novel approach to induce chronic kidney disease (CKD) with severe anemia by oral administration of adenine in rodents. Adenine was administered to 6-week-old male C57BL/6 mice (25 and 50 mg/kg body weight) by oral gavage daily for 28 days. Serum creatinine and BUN as well as hematocrit, hemoglobin (Hb) and plasma erythropoietin (EPO) levels were monitored to assess renal function and anemia, respectively. Adenine at 25 mg/kg for 28 days slightly increased plasma creatinine levels, but did not induce anemia. In contrast, 50 mg/kg of adenine daily for 28 days showed severe renal dysfunction (plasma creatinine 1.9 ± 0.10 mg/dL) and anemia (hematocrit 36.5 ± 1.0% and EPO 28 ± 2.4 pg/mL) as compared with vehicle-treated mice (0.4 ± 0.02 mg/dL, 49.6 ± 1.6% and 61 ± 4.0 pg/mL, respectively). At the end of experiment, level of Hb also significantly reduced in 50 mg/kg adenine administration group. Remarkable histological changes of kidney tissues characterized by interstitial fibrosis and cystic appearance in tubules were observed in 50 mg/kg of adenine treatment group. These results have demonstrated that oral dosing with adenine at 50 mg/kg for 28 days is suitable to induce a stable anemia associated with CKD in mice.

Background Previous studies on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have found that those who died in hospital had higher blood urea nitrogen levels and a worse nutritional status compared to survivors. However, the association between the blood urea nitrogen to serum albumin ratio (BUN/ALB ratio) and in-hospital and short-term prognosis in patients with AECOPD remains unclear. The aim of this study was to explore the usefulness of BUN/ALB ratio in AECOPD as an objective predictor for in-hospital and 90-day all-cause mortality. Methods We recorded the laboratory and clinical data in patients with AECOPD on admission. By drawing the ROC curve for the patients, we obtained the cut-off point for the BUN/ALB ratio for in-hospital death. Multivariate logistic regression was used for analyses of the factors of in-hospital mortality and multivariate Cox regression was used to analyze the factors of 90-day all-cause mortality. Results A total of 362 patients were recruited and 319 patients were finally analyzed. Twenty-three patients died during hospitalization and the fatality rate was 7.2%. Furthermore, 14 patients died by the 90-day follow-up. Compared with in-hospital survivors, patients who died in hospital were older (80.78 ± 6.58 vs. 75.09 ± 9.73 years old, P  = 0.001), had a higher prevalence of congestive heart failure(69.6% vs. 27.4%, P  < 0.001), had a higher BUN/ALB ratio [0.329 (0.250–0.399) vs. 0.145 (0.111–0.210), P  < 0.001], had higher neutrophil counts [10.27 (7.21–14.04) vs. 6.58 (4.58–9.04), P  < 0.001], higher blood urea nitrogen levels [10.86 (7.10–12.25) vs. 5.35 (4.14–7.40), P  < 0.001], a lower albumin level (32.58 ± 3.72 vs. 36.26 ± 4.53, P  < 0.001) and a lower lymphocyte count [0.85 (0.58–1.21) vs. 1.22 (0.86–1.72), P  = 0.001]. The ROC curve showed that the area under the curve (AUC) of BUN/ALB ratio for in-hospital death was 0.87, (95%CI 0.81–0.93, P  < 0.001), the best cut-off point value to discriminate survivors from non-survivors in hospital was 0.249, the sensitivity was 78.3%, the specificity was 86.5%, and Youden’s index was 0.648. Having a BUN/ALB ratio ≥ 0.249 was an independent risk factor for both in-hospital and 90-day all-cause mortality after adjustment for relative risk (RR; RR = 15.08, 95% CI 3.80–59.78, P  < 0.001 for a multivariate logistic regression analysis) and hazard ratio (HR; HR = 5.34, 95% CI 1.62–17.57, P  = 0.006 for a multivariate Cox regression analysis). Conclusion An elevated BUN/ALB ratio was a strong and independent predictor of in-hospital and 90-day all-cause mortality in patients with AECOPD.

Low blood glucose levels and high urea nitrogen levels affect patient prognosis, but few studies have investigated whether the blood urea nitrogen to glucose (BGR) ratio predicts the risk of death.This retrospective research examined the connection between the BGR and 365-day mortality in patients with chronic kidney disease (CKD) stages 1–4 admitted to an intensive care unit (ICU). The study utilized data from 6,380 patients in the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2), taking into account confounding factors such as demographics, vital signs, laboratory indicators, and comorbidities. The study employed both univariate and multivariate Cox regression analyses stratified by BGR quartiles. Additionally, restricted cubic spline regression and inflection point analysis were used to explore the linear relationship between BGR and 365-day mortality, while Kaplan-Meier curve analysis was used to observe mortality changes under different BGR stratifications. Subgroup and mediating effect analyses were performed to evaluate the robustness of BGR’s effect on 365-day mortality. The study found a cumulative 365-day mortality rate of 34.2% among CKD stages 1–4 patients, with a 2.43-fold increase in the risk of death associated with BGR and at least a 44% increase in the risk of death for each unit increase in BGR ( P  = 0.022). A significant nonlinear relationship was identified, showing a stepwise change in the risk of death with a marked increase in the slope of the curve for BGR values below 0.52 and above 0.9 ( P  < 0.001). Subgroup analyses indicated interactions between BGR and factors such as age, sepsis, first-day antibiotic use, and cerebrovascular disease ( P  < 0.05). In conclusion, this study confirms that BGR is a significant and stable predictor of 1-year mortality risk in patients with CKD stages 1–4. Interventions aimed at timely adjustment, correction of metabolic imbalances, reduction of inflammation, and management of BGR levels are beneficial for reducing mortality in this patient population.

The study aimed to assess the predictive value of blood urea nitrogen (BUN)-to-albumin ratio (BA-R) for in-hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection (ATAAD). Patients who were diagnosed with ATAAD and underwent emergency surgery within 48 hours of onset at our hospital between January 2015 and December 2021 were included in this study. The primary endpoint of this study was postoperative in-hospital mortality (POIM). The data of the survivors and non-survivors were retrospectively compared analyses. A total of 557 ATAAD patients were included, with 505 survivors and 52 non-survivors. The preoperative BA-R of the non-survivor group was significantly higher than that of the survivor group ( P  < 0.001). Univariate regression analysis showed that preoperative BA-R, serum creatinine level, SA level, D-dimer level, age, myocardial ischemia, cerebral ischemia, and aortic clamp time were risk factors for POIM. In addition, multivariable regression analysis showed that preoperative BA-R ≥ 0.155 mmol/g was a risk factor for POIM (odds ratio, 6.815 [3.582–12.964]; P  < 0.001). Receiver operating characteristic curve indicated that the cut-off point for preoperative BA-R was ≥0.155 mmol/g (area under the curve =0.874). The sensitivity and specificity of preoperative BA-R in predicting the POIM of patients who underwent emergency surgery for ATAAD were 84.6% and 71.3%, respectively (95% confidence interval, 0.829–0.919; P  < 0.001). In conclusion, Preoperative BA-R is a simple, rapid, and potentially useful prognostic indicator of POIM in patients with ATAAD.

This study aims to investigate the association between the blood urea nitrogen-to-creatinine (BUN/Cr) ratio and 28-day mortality in critically ill patients with acute kidney injury (AKI) who received continuous renal replacement therapy (CRRT). We conducted a retrospective cohort study using data from the DATADRYAD database ( www.datadryad.org ). The study population was divided into four groups based on the quartiles of BUN/Cr levels measured prior to the initiation of CRRT. Multivariate Cox proportional hazards models and Kaplan–Meier analysis were used to assess this relationship, while restricted cubic spline (RCS) analysis was utilized to explore potential non-linear associations. Additionally, subgroup analysis was conducted to assess consistency across groups. A total of 1,137 critically ill patients with AKI who received CRRT were included. The highest BUN/Cr quartile demonstrated a significantly increased mortality risk (HR: 1.66, 95% CI: 1.34–2.06, p  < 0.001) compared to the lowest quartile. Multivariate Cox regression analysis revealed that, even after adjusting for potential confounders, an elevated BUN/Cr ratio remained a significant and independent predictor of increased 28-day mortality. RCS analysis revealed a J-shaped relationship (p for nonlinearity < 0.001) between the BUN/Cr ratio and 28-day mortality, with a sharp increase in the risk of death above the threshold of 15.0. Subgroup analysis confirmed consistency across most subgroups, except for patients with hypertension (p for interaction = 0.035), where the association was stronger in individuals with hypertension. Higher BUN/Cr ratios are independently associated with increased 28-day mortality in AKI patients who received CRRT, exhibiting a non-linear relationship. The BUN/Cr ratio may serve as a cost-effective and accessible prognostic marker for this population, helping to identify high-risk patients for targeted interventions.

Previous studies have reported the association between blood urea nitrogen (BUN) and cardiovascular diseases (CVDs) but the causality has not yet been proved. Our study aimed to assess the causal effect of BUN levels on several CVDs using the two-sample Mendelian randomization (MR) method. This is the first MR study examining causal relationships between BUN and multiple cardiovascular diseases. Using data from genome-wide association studies (GWAS) of East Asians, we identified single nucleotide polymorphisms (SNPs) associated with BUN levels as instrumental variables. Specifically, SNPs reaching genome-wide significance (  < 5 × 10 ) were selected from a large-scale BUN dataset comprising (  = 148,767). To ensure robustness, multiple MR methods, including MR-Egger, weighted median, inverse variance weighting (IVW), simple mode, and weighted mode, were employed to evaluate the causal relationship between BUN levels and CVDs. Sensitivity analyses were conducted to assess the reliability and stability of the results. The IVW approach showed that a higher level of BUN was associated with an increased risk of coronary artery disease (CAD) (OR = 1.42, 95% CI = 1.226 - 1.644,  = 2.89 × 10 ). For atrial fibrillation (OR = 0.868, 95% CI = 0.678 - 1.110,  = 0.258), arrhythmia (OR = 0.907, 95% CI = 0.777 - 1.059,  = 0.216), and congestive heart failure (OR = 0.924, 95% CI = 0.781 - 1.092,  = 0.353), no significant associations were found. Sensitivity analyses indicated the results were robust. This MR work shows that elevated BUN levels are a potential biomarker for CAD risk but lack causal associations with other CVDs. These findings suggest avenues for risk stratification and CAD prevention strategies, emphasizing the clinical utility of BUN monitoring in at-risk populations.

To explore the associations between the blood urea nitrogen-to-creatinine ratio (BCR), acute kidney injury (AKI), and in-hospital mortality in coronavirus disease 2019 (COVID-19) patients. COVID-19 patients from Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine were enrolled in this study. Clinical data and laboratory parameters were collected. AKI was defined using two serum creatinine tests according to KDIGO guidelines. Cox regression and receiver operating characteristic (ROC) curve analyses were performed. Five hundred and sixty-seven COVID-19 patients were enrolled, 44.1% of whom were male. The mean age was 75 years. Among all patients, 17 patients developed AKI, and 30 patients died during hospitalization. Compared to non-AKI patients, the BCR in AKI patients was significantly greater. BCR was significantly associated with AKI (unadjusted HR 1.04, 95% CI: 1.02-1.05,  < 0.001; adjusted HR 1.06, 95% CI 1.02-1.10,  = 0.001). BCR was also a risk factor of in-hospital mortality (unadjusted HR 1.03, 95% CI: 1.02-1.05,  < 0.001; adjusted HR 1.04, 95% CI: 1.01-1.08,  = 0.019). The BCR threshold was 38.9, with 70.6% sensitivity and 87.1% specificity for predicting AKI, while a threshold of 33.0 predicted mortality. Subgroup analysis revealed that BCR could predict AKI and mortality in different subgroups according to sex, age, diabetes mellitus, and estimated glomerular filtration rate. The BCR, a simple index, is associated with AKI onset and mortality in COVID-19 patients. The BCR possesses certain specificity for AKI screening, which indicates an effective clinical indicator for screening patients at high risk of AKI.

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.