Hongjuan Liu,1 Yanli Tang,1 Quan Zhou,1 Jing Zhang,2 Xin Li,1 Hui Gu,1 Bohong Hu,1 Yandeng Li1 

1Changde Hospital, Xiangya School of Medicine, Central South University, Changde, 415000, People’s Republic of China; 2Lixian People’s Hospital, Changsha Medical University, Lixian, 415500, People’s Republic of China

Correspondence: Bohong Hu; Yandeng Li, Email 1524226948@qq.com; bssjlk@yeah.net

Objective: This study targeted elucidating the intricate correlation of the blood urea nitrogen (BUN)-to-albumin (BUN/Alb) ratio with adverse outcomes (AOs) at 3-month in acute ischemic stroke (AIS) cases within a Korean cohort.
Methods: The cohort involved a comprehensive dataset of 1850 AIS cases from a South Korean hospital, spanning from January 2010 to December 2016. To discern the linear relationship of the BUN/Alb ratio with AOs in AIS cases, utilization of a binary logistic regression model (BLRM) was implemented. Additionally, it was attempted to utilize sophisticated statistical techniques, such as generalized additive models (GAMs) and smooth curve fitting methods, to unravel the nonlinear association of the BUN/Alb ratio with AOs in such patients.
Results: The incidence of AOs was determined to be 28.49%, with the median BUN/Alb ratio being 3.85. After adjusting for a number of covariates, the BLRM disclosed that the linear association of BUN/Alb ratio with the risk of AOs particularly in AIS cases did not achieve statistical significance. However, a noticeable nonlinear relationship emerged, with an inflection point identified at 2.86. To the left of this inflection point, the relationship is not statistically significant. On the right side of the inflection point, there was a remarkable 9.47% rise in the risk of AOs (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.00, 1.19, P = 0.04).
Conclusion: The outcomes illuminate the complex and nonlinear relationship of the BUN/Alb ratio with 3-month AOs in AIS cases. This study established a robust groundwork for the future research, underscoring the potential clinical utility of monitoring the BUN/Alb ratio to enhance the prognostic assessment and management of AIS cases.

Keywords: blood urea nitrogen 1, albumin 2, stroke 3, adverse outcomes 4, cohort study 5