Can the blood urea nitrogen to serum albumin ratio be used as a mortality predictor in patients with pneumonia after cardiac surgery?

Objectives: Acute ischemic stroke (AIS) is one of the most important and major causes of mortality worldwide. In AIS patients, the blood urea nitrogen to creatinine ratio (B/C ratio) was investigated as a dehydrated biomarker in previous studies. However, the B/C ratio can be affected by medications and past medical history. We hypothesized addition of serum albumin, which has been shown to have beneficial neuroprotective effects, could compensate for the disadvantages. In the present study, the BUN to serum albumin ratio (B/A ratio) was evaluated association with AIS patient’s prognosis. Methods: This retrospective cohort study of AIS in our hospital was conducted from February 2018 through June 2020. First, demographic and clinical data were collected and compared with the prevalence of mortality and ICU admission. Then, the B/C ratio and the B/A ratio were calculated. Differences in the performance between the B/C ratio and the B/A ratio for outcome prediction were evaluated based on the area under the curve of the receiver operating characteristic (AUROC). Results: Among the 1,164 patients enrolled in this study, 77 (6.6%) died during hospitalization and 467 (40.1%) were admitted to ICU. Multivariate logistic regression had shown that the B/A ratio was a significant predictor of mortality and admission to ICU. In addition, the B/A ratio was significantly higher in ICU-admitted patients and non-survivors. The AUROC of the B/A ratio was 0.687 and the B/C ratio was 0.533 for predicting mortality; the B/A ratio was statistically superior to the B/C ratio. For predicting ICU admission, the AUROC values of the B/A ratio and the B/C ratio were 0.567 and 0.556, respectively, and a statistically significant difference was not observed. Conclusion: The B/A ratio is a simple and useful tool for predicting the outcomes of ischemic stroke patients.

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A-DROP and Blood Urea Nitrogen-to-Serum Albumin Ratio are Useful in Assessing the Severity of Pneumocystis Pneumonia in Patients Without Human Immunodeficiency Virus Infection: A Retrospective Study

10.21203/rs.3.rs-52173/v1 ◽

2020 ◽

Author(s):

Jumpei Akahane ◽

Atsuhito Ushiki ◽

Makoto Kosaka ◽

Yuichi Ikuyama ◽

Akemi Matsuo ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Prognostic Factors ◽

Retrospective Study ◽

Serum Albumin ◽

Blood Urea Nitrogen ◽

Treatment Initiation ◽

Community Acquired Pneumonia ◽

Urea Nitrogen ◽

Albumin Ratio ◽

Immunodeficiency Virus

Abstract Background: There is an increasing incidence of Pneumocystis pneumonia among individuals without the human immunodeficiency virus (HIV) infection (non-HIV Pneumocystis pneumonia). However, the prognostic factors for patients with non-HIV Pneumocystis pneumonia have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio, which is reported to be predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV Pneumocystis pneumonia. In this study, we analyzed the prognostic factors for non-HIV Pneumocystis pneumonia and evaluated the effectiveness of A-DROP and the blood urea nitrogen-to-serum albumin ratio as prognostic factors.Methods: This retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV Pneumocystis pneumonia between January 2003 and May 2019 at five medical facilities. Prognostic factors associated with the 30-day mortality were assessed using multiple logistic regression analysis.Results: Among the 102 patients with non-HIV Pneumocystis pneumonia, 46 (45.1%) had autoimmune diseases, 19 (18.6%) had hematological malignancies, 18 (17.7%) had solid malignancies, and 19 (18.6%) had other diseases. The 30-day mortality rate for non-HIV Pneumocystis pneumonia was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and a significantly higher age, corticosteroid dosage at the onset of Pneumocystis pneumonia, alveolar–arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and blood urea nitrogen-to-serum albumin ratio. The results of multivariate analysis showed that a high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation were significantly associated with the 30-day mortality risk.Conclusions: A high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation are independent prognostic predictors of mortality risk in patients with non-HIV Pneumocystis pneumonia.

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