Blood Urea Nitrogen to Serum Albumin Ratio as A New Prognostic Indicator in Critically Ill Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study

Abstract

Purpose: Diabetic ketoacidosis (DKA) remains a life-threatening medical emergency. Blood urea nitrogen to serum albumin (BAR) demonstrated good predictive ability in the mortality of patients with various diseases. The study aimed to investigate the predictive value of BAR for in- and out-of-hospital mortality in critically ill patients with DKA. Methods: Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC-III) database and all the eligible subjects were divided into two groups by a cutoff value of BAR. The multiple logistic regression analysis was conducted to determine the association between BAR and in-hospital mortality. The predictive performance of BAR was evaluated by Kaplan–Meier (K-M) analysis. Propensity score matching (PSM) was applied to control confounding factors between the low BAR and high BAR groups. Results: A total of 589 critically ill DKA patients were enrolled. DKA patients with a higher BAR level were associated with higher in-hospital mortality and out-hospital mortality (all p<0.001). There was a significant four-year survival difference between the low and high BAR groups (p<0.0001). After PSM analysis, two PSM groups (202 pairs, n = 404) were generated, and similar results were observed in the K-M curve (p<0.0001). Conclusions: Elevated levels of BAR were associated with an increased risk of in-hospital mortality in critically ill patients with DKA, and BAR could be an independent prognostic factor in in-hospital mortality and out-hospital mortality for patients diagnosed with DKA.

Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality in critical patients with diabetic ketoacidosis: a retrospective analysis of the eICU database

“…A previous study by Hang et al. demonstrated that elevated levels of BAR were associated with a higher risk of in-hospital mortality in critical DKA patients ( 25 ). Our study aimed to further investigate this relationship using a larger sample size and a multi-center approach.…”