Prognostic value of the blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients: a large-scale retrospective cohort study using the Medical Information Mart for Intensive Care IV database.
- 1Capital Medical University, Beijing Shijitan Hospital, Department of Surgical Intensive Care Unit - Beijing, China.
- 2Capital Medical University, Beijing Shijitan Hospital, Department of Anesthesiology - Beijing, China.
Abstract
Objective
Sepsis is a life-threatening condition characterized by dysregulated host responses to infection and high mortality in intensive care units. Existing prognostic models are often complex or resource-intensive. The blood urea nitrogen-to-albumin ratio, reflecting renal function, metabolic stress, and nutritional status, has emerged as a potential prognostic biomarker. The aim of this study was to evaluate the predictive value of blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients.Methods
This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Adult patients meeting Sepsis-3 criteria were included. Suspected infection was defined by antibiotic administration and microbiological culture within 24 h. Demographic, clinical, and laboratory data were collected, and blood urea nitrogen-to-albumin ratio was calculated using values obtained within the first 24 h of intensive care unit admission. Receiver operating characteristic curve analysis, Kaplan-Meier survival analysis, and multivariate Cox regression were performed.Results
A total of 6,940 patients were included, with a 28-day mortality rate of 21.6%. Blood urea nitrogen-to-albumin ratio demonstrated superior predictive performance (area under the curve (AUC)=0.647, 95%CI 0.631-0.664) compared with serum urea (AUC=0.634) and albumin (AUC=0.428), and also outperformed the Sequential Organ Failure Assessment score (AUC=0.613). The optimal cutoff value was 7.6. Patients with blood urea nitrogen-to-albumin ratio ≥7.6 had significantly higher mortality than those with lower values (p<0.001). Elevated blood urea nitrogen-to-albumin ratio remained an independent predictor of mortality after adjustment.Conclusion
Blood urea nitrogen-to-albumin ratio is a simple, objective, and readily available biomarker associated with 28-day mortality in septic intensive care unit patients and may contribute to risk stratification when used alongside other clinical parameters.
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BibTeX
@article{hou2026prognostic,
title = {{Prognostic value of the blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients: a large-scale retrospective cohort study using the Medical Information Mart for Intensive Care IV database.}},
author = {Jiatong Hou and Jiaqi Cheng and Wentao Liu and Yuefu Wang},
journal = {Revista da Associacao Medica Brasileira (1992)},
year = {2026},
month = oct,
doi = {10.1590/1806-9282.20260593},
url = {https://europepmc.org/article/MED/42912053},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic value of the blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients: a large-scale retrospective cohort study using the Medical Information Mart for Intensive Care IV database.
AU - Jiatong Hou
AU - Jiaqi Cheng
AU - Wentao Liu
AU - Yuefu Wang
PY - 2026
DA - 2026/10/12
JO - Revista da Associacao Medica Brasileira (1992)
DO - 10.1590/1806-9282.20260593
UR - https://europepmc.org/article/MED/42912053
AB - Objective Sepsis is a life-threatening condition characterized by dysregulated host responses to infection and high mortality in intensive care units. Existing prognostic models are often complex or resource-intensive. The blood urea nitrogen-to-albumin ratio, reflecting renal function, metabolic stress, and nutritional status, has emerged as a potential prognostic biomarker. The aim of this study was to evaluate the predictive value of blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Adult patients meeting Sepsis-3 criteria were included. Suspected infection was defined by antibiotic administration and microbiological culture within 24 h. Demographic, clinical, and laboratory data were collected, and blood urea nitrogen-to-albumin ratio was calculated using values obtained within the first 24 h of intensive care unit admission. Receiver operating characteristic curve analysis, Kaplan-Meier survival analysis, and multivariate Cox regression were performed.Results A total of 6,940 patients were included, with a 28-day mortality rate of 21.6%. Blood urea nitrogen-to-albumin ratio demonstrated superior predictive performance (area under the curve (AUC)=0.647, 95%CI 0.631-0.664) compared with serum urea (AUC=0.634) and albumin (AUC=0.428), and also outperformed the Sequential Organ Failure Assessment score (AUC=0.613). The optimal cutoff value was 7.6. Patients with blood urea nitrogen-to-albumin ratio ≥7.6 had significantly higher mortality than those with lower values (p<0.001). Elevated blood urea nitrogen-to-albumin ratio remained an independent predictor of mortality after adjustment.Conclusion Blood urea nitrogen-to-albumin ratio is a simple, objective, and readily available biomarker associated with 28-day mortality in septic intensive care unit patients and may contribute to risk stratification when used alongside other clinical parameters.
SN - 0104-4230
SN - 1806-9282
ER -