High blood urea nitrogen to serum albumin ratio may increase mortality risk in DM patients with CKD: Study

A recent study published in the recent edition of Nature Scientific Reports highlight on a critical aspect of managing critically ill patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This retrospective study assessed the relationship between the Blood Urea Nitrogen to Serum Albumin Ratio (BAR) and mortality outcomes in this patient population.

After utilizing vast reservoir of the Medical Information Mart database Shizhen Liu and colleagues conducted a comprehensive analysis by enrolling a total of 1920 patients. These individuals suffered the dual burden of T2DM and CKD and were meticulously divided into three groups based on their BAR levels: BAR < 9.2, 9.2 ≤ BAR ≤ 21.3 and BAR > 21.3. The primary focus of the study was to elucidate the impact of BAR on 90-day mortality, while also exploring secondary outcomes such as the length of ICU stay, hospital mortality and 30-day mortality.

The key findings of the study were;

The patients with BAR levels exceeding 21.3 expressed significantly prolonged ICU stays and markedly elevated rates of 30-day and 90-day mortality when compared to their counterparts in lower BAR groups. Also, the cox regression analysis revealed a clear association between higher BAR levels and an augmented risk of 90-day mortality.

The adjusted hazard ratios (HR) from the regression models solidified the significance of BAR as a prognostic indicator. Even after accounting for various confounding factors like the age, comorbidities and severity of illness, the relationship between increased BAR levels and elevated mortality risk remained robust. The subgroup analyses underlined the consistency of these findings across different patient demographics and clinical scenarios by reinforcing the reliability of BAR as a predictive tool.

The gravity of these results was graphically depicted through Kaplan–Meier survival curve analysis that vividly portrayed the stark divergence in 90-day survival rates based on BAR levels. The individuals with BAR > 21.3 faced substantially lower survival probabilities by highlighting the critical importance of this marker in risk stratification and clinical decision-making. In conclusion, this study elucidates the potential of BAR as a simple yet invaluable prognostic tool in the management of T2DM patients with CKD in the intensive care unit (ICU).

Reference:

Liu, S., Qiu, C., Li, W., Li, X., Liu, F., & Hu, G. (2024). Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in type 2 diabetes mellitus patients with chronic kidney disease. In Scientific Reports (Vol. 14, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1038/s41598-024-58678-4