■本研究旨在探讨尿素氮与血清白蛋白比值(BAR)与急性肾损伤(AKI)患者全因死亡率的关系,并评估BAR对AKI预后的影响。
■在一项回顾性队列研究中选择了在医学信息集市重症监护IV(MIMIC-IV)中入住ICU的成年AKI患者。使用初始血尿素氮(mg/dl)/血清白蛋白(g/dl)计算BAR(mg/g)。根据BAR,这些患者分为四分位数(Q1-Q4).采用Kaplan-Meier分析比较上述四组的死亡率。多因素Cox回归分析用于评估BAR与28天死亡率和365天死亡率之间的关联。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),亚组分析最终通过相关协变量分层。
■本研究共纳入12,125例AKI患者。28天和365天死亡率分别为23.89和39.07%,分别。Kaplan-Meier分析显示,高BAR患者的全因死亡率显著增加(Log-rankp<0.001)。多因素Cox回归分析显示,BAR是28天死亡率的独立危险因素(4.3213.03:HR2.07,95%CI1.32,p<0.001;B4.63%B93%1.64BAR预测28天死亡率和365天死亡率的AUC分别为0.649和0.662,优于血尿素氮和序贯器官衰竭的评估。此外,亚组分析显示,AKI患者的BAR与不良结局之间存在稳定的关系.
■BAR与AKI患者全因死亡率增加显著相关。这一发现表明,BAR可能有助于识别具有高死亡风险的AKI患者。
UNASSIGNED: This study aims to investigate the relationship between blood urea nitrogen to serum albumin ratio (BAR) and all-cause mortality in patients with acute kidney injury (AKI) and evaluate the effect of BAR on the prognosis of AKI.
UNASSIGNED: Adult patients with AKI admitted to the ICU in the Medical Information Mart for Intensive Care IV (MIMIC-IV) were selected in a retrospective cohort study. BAR (mg/g) was calculated using initial blood urea nitrogen (mg/dl)/serum albumin (g/dl). According to the
BAR, these patients were divided into quartiles (Q1-Q4). Kaplan-Meier analysis was used to compare the mortality of the above four groups. Multivariate Cox regression analysis was used to evaluate the association between BAR and 28-day mortality and 365-day mortality. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated, and the subgroup analysis was finally stratified by relevant covariates.
UNASSIGNED: A total of 12,125 patients with AKI were included in this study. The 28-day and 365-day mortality rates were 23.89 and 39.07%, respectively. Kaplan-Meier analysis showed a significant increase in all-cause mortality in patients with high BAR (Log-rank p < 0.001). Multivariate Cox regression analysis showed that BAR was an independent risk factor for 28-day mortality (4.32 <
BAR≤7.14: HR 1.12, 95% CI 0.97-1.30, p = 0.114; 7.14 <
BAR≤13.03: HR 1.51, 95% CI 1.31-1.75, p < 0.001;
BAR>13.03: HR 2.07, 95% CI 1.74-2.47, p < 0.001; Reference
BAR≤4.32) and 365-day mortality (4.32 <
BAR≤7.14: HR 1.22, 95% CI 1.09-1.36, p < 0.001; 7.14 <
BAR≤13.03: HR 1.63, 95% CI 1.46-1.82, p < 0.001;
BAR>13.03: HR 2.22, 95% CI 1.93-2.54, p < 0.001; Reference
BAR ≤ 4.32) in patients with AKI. The AUC of BAR for predicting 28-day mortality and 365-day mortality was 0.649 and 0.662, respectively, which is better than that of blood urea nitrogen and sequential organ failure assessment. In addition, subgroup analysis showed a stable relationship between BAR and adverse outcomes in patients with AKI.
UNASSIGNED: BAR is significantly associated with increased all-cause mortality in patients with AKI. This finding suggests that BAR may help identify people with AKI at high risk of mortality.