Objective To investigate the ability of the ratio of blood urea nitrogen (BUN) to serum albumin ratio (BAR) in patients with sepsis in intensive care units (ICUs) to predict the prognosis of short-and long-term death. Methods Data were derived from the Medical Information Market in the Intensive Care IV (MIMIC-IV v2.0) database, with septic patients defined by SEPSIS-3. 30-day mortality for the primary outcome and 360-day mortality for the secondary outcome. Kaplan-Meier (KM) Survival curves were plotted to describe differences in BAR mortality in different subgroups, and area under the curve (AUC) analysis was performed to a comparison of BAR + SOFA and sequential organ failure assessment (SOFA) performance. Multivariate Cox regression models, restricted cubic spline curves (RCS), and subgroup analysis were used to ascertain the correlation between BAR and 30-day mortality and 360-day mortality. Results A total of 7656 eligible patients with a median BAR of 8.0 mg/g were enrolled in the study, with 3837 patients in the ≤ 8.0 group and 3819 in the BAR > 8.0 group, with 30-day mortality rates of (19.1% and 38.2%; P < 0.001)The area under the curve (AUC) was 0.718 (95% CI: 0.705–0.731) for SOFA + BAR and 0.703 (95% CI: 0.690–0.716) for SOFA. In the subgroup analysis, BAR remained an isolated risk element for patient death. For 360-day all-cause mortality, the same pattern was observed after adjustment for the same confounders. Conclusion As a clinically inexpensive and readily available parameter, BAR can be a valuable forecaster of prognosis in patients with sepsis in the intensive care unit.
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