Jili Li,1 Jianyue Peng,1 Chuke Cheng,1 Julin Zhang,1 Lei Li2 

1West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China

Correspondence: Lei Li, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, People’s Republic of China, Email lilei41lilei@163.com

Background: Epidemiological studies suggest that elevated blood urea nitrogen (BUN) and reduced serum albumin could independently predict adverse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). However, the predictive performance of BUN-albumin ratio (BAR) in critically ill patients with COPD remains to be confirmed. This study aimed to investigate the association between BAR and all-cause mortality in intensive care unit (ICU) patients with COPD.
Methods: This was a retrospective study that included COPD patients with BUN and serum albumin value on the first day of each ICU admission and data were obtained from the eICU Collaborative Research Database. The included COPD patients were divided into three groups stratified by BAR tertiles (T1-T3). Multivariate logistic regression and Cox proportional hazards models were used to examine the association between BAR and all-cause in-hospital and ICU mortality, respectively. Kaplan–Meier curves were plotted to evaluate survival differences among three groups and discrepancies were compared with the log–rank test.
Results: A total of 4037 patients were included in the final analysis and the in-hospital and ICU mortality rates were 11.79% and 6.51%, respectively. The multivariate logistic regression analyses showed that continuous BAR was a significant risk predictor of in-hospital mortality (OR: 1.039, 95% CI: 1.026– 1.052, P < 0.001) and ICU mortality (OR: 1.030, 95% CI: 1.015– 1.045, P < 0.001) in fully adjusted model. The Cox proportional hazards models revealed that patients in the highest BAR tertile (T3) were significantly associated with higher risk of in-hospital mortality (HR: 1.983, 95% CI: 1.419– 2.772, P < 0.001) and ICU mortality (HR: 2.166, 95% CI: 1.373– 3.418, P < 0.001). The Kaplan–Meier curves showed that the survival differences of all-cause mortality were statistically significant in three tertile groups (log-rank P < 0.0001). Correlated subgroup analyses indicated that this positive association might vary in certain population settings.
Conclusion: High level of BAR is associated with the increasing all-cause mortality in critically ill patients with COPD. As an innovative and promising biomarker, BAR might be useful in predicting high risk of death in patients with COPD.

Keywords: chronic obstructive pulmonary disease, blood urea nitrogen, serum albumin, all-cause mortality, intensive care unit