Abstract：
OBJECTIVE: To investigate the predictive power of the BUN/albumin ratio (BAR) measured in the emergency department (ED) for the requirement of renal replacement therapy (RRT) in patients admitted to the intensive care unit (ICU) with severe COVID-19 pneumonia and acute kidney injury (AKI).
METHODS: The study included 117 patients with AKI who were admitted to the ICU and had COVID-19 pneumonia detected on chest computed tomography (CT) taken in the ED\'s pandemic area between November 1, 2020, and June 1, 2021. The predictive power of laboratory values measured at the time of ED admission for the requirement of RRT was analyzed.
RESULTS: Of the patients, 59.8% (n = 70) were male, with an average age of 71.7 ± 14.8 years. The mortality rate of the study was 35% (n = 41). During follow-up, 23.9% (n = 28) of the patients required RRT. Laboratory parameters measured at the time of ED admission showed that patients who required RRT had significantly higher BAR, BUN, and creatinine levels, and significantly lower albumin levels (all p < 0.001). ROC analysis to determine the predictive characteristics for RRT requirement revealed that the BAR had the highest AUC value (AUC, 0.885; 95% CI 0.825-0.945; p < 0.001). According to the study data, for BAR, a cut-off value of 1.7 resulted in a sensitivity of 96.4% and a specificity of 71.9%.
CONCLUSIONS: In patients with severe pneumonia who develop acute kidney injury, the BUN/albumin ratio may guide clinicians early in predicting the need for renal replacement therapy.
METHODS: The study included 117 patients with AKI who were admitted to the ICU and had COVID-19 pneumonia detected on chest computed tomography (CT) taken in the ED\'s pandemic area between November 1, 2020, and June 1, 2021. The predictive power of laboratory values measured at the time of ED admission for the requirement of RRT was analyzed.
RESULTS: Of the patients, 59.8% (n = 70) were male, with an average age of 71.7 ± 14.8 years. The mortality rate of the study was 35% (n = 41). During follow-up, 23.9% (n = 28) of the patients required RRT. Laboratory parameters measured at the time of ED admission showed that patients who required RRT had significantly higher BAR, BUN, and creatinine levels, and significantly lower albumin levels (all p < 0.001). ROC analysis to determine the predictive characteristics for RRT requirement revealed that the BAR had the highest AUC value (AUC, 0.885; 95% CI 0.825-0.945; p < 0.001). According to the study data, for BAR, a cut-off value of 1.7 resulted in a sensitivity of 96.4% and a specificity of 71.9%.
CONCLUSIONS: In patients with severe pneumonia who develop acute kidney injury, the BUN/albumin ratio may guide clinicians early in predicting the need for renal replacement therapy.
摘要：
目的：探讨急诊科（ED）测定的BUN/白蛋白比值（BAR）对重症监护病房（ICU）重症COVID-19肺炎和急性肾损伤（AKI）患者肾脏替代治疗（RRT）需求的预测能力。
方法：该研究纳入了117例AKI患者，这些患者于2020年11月1日至2021年6月1日在ED大流行地区进行的胸部计算机断层扫描（CT）检查发现了COVID-19肺炎。分析了ED入院时对RRT要求的实验室值的预测能力。
结果：在患者中，59.8%(n=70)为男性，平均年龄71.7±14.8岁。该研究的死亡率为35％（n=41）。随访期间,23.9%(n=28)的患者需要RRT。在ED入院时测得的实验室参数表明，需要RRT的患者的BAR明显较高，BUN,和肌酐水平，和显着降低白蛋白水平（所有p<0.001）。确定RRT要求的预测特征的ROC分析显示，BAR具有最高的AUC值（AUC，0.885；95%CI0.825-0.945；p<0.001）。根据研究数据,对于BAR，截断值为1.7时,敏感性为96.4%,特异性为71.9%.
结论：在发生急性肾损伤的重症肺炎患者中，BUN/白蛋白比值可指导临床医师早期预测是否需要肾脏替代治疗.
方法：该研究纳入了117例AKI患者，这些患者于2020年11月1日至2021年6月1日在ED大流行地区进行的胸部计算机断层扫描（CT）检查发现了COVID-19肺炎。分析了ED入院时对RRT要求的实验室值的预测能力。
结果：在患者中，59.8%(n=70)为男性，平均年龄71.7±14.8岁。该研究的死亡率为35％（n=41）。随访期间,23.9%(n=28)的患者需要RRT。在ED入院时测得的实验室参数表明，需要RRT的患者的BAR明显较高，BUN,和肌酐水平，和显着降低白蛋白水平（所有p<0.001）。确定RRT要求的预测特征的ROC分析显示，BAR具有最高的AUC值（AUC，0.885；95%CI0.825-0.945；p<0.001）。根据研究数据,对于BAR，截断值为1.7时,敏感性为96.4%,特异性为71.9%.
结论：在发生急性肾损伤的重症肺炎患者中，BUN/白蛋白比值可指导临床医师早期预测是否需要肾脏替代治疗.
