Association of blood urea nitrogen to serum albumin ratio with mortality in ICU patients with sepsis-induced coagulopathy: A Retrospective Cohort Study from MIMIC-IV database

Clinical Snapshot

Key Findings

• P Value: P < 0.001

• Effect Size: Adjusted HR 1.18 per 10-unit BAR increase

• Primary Outcome: 30-day mortality

• Nnt Or Sensitivity: Highest tertile (BAR ≥10 mg/g): adjusted HR 1.69 (95% CI 1.43-2.00) vs lowest tertile

• Confidence Interval: 95% CI 1.12-1.24

Clinical Application

High feasibility as BAR uses routine laboratory tests (BUN, albumin) available in all ICUs Relevant to Australian ICUs as BUN and albumin are standard pathology tests covered by Medicare, aligns with sepsis management protocols in Australian intensive care guidelines ICU patients with sepsis-induced coagulopathy in tertiary care settings

Abstract

The blood urea nitrogen to serum albumin ratio (BAR) has shown promise as a prognostic marker in sepsis, yet its specific role in sepsis-induced coagulopathy (SIC) remains unclear. We aimed to clarify whether BAR informs mortality risk in critically ill intensive care unit (ICU) patients with SIC. Using the Medical Information Mart for Intensive Care IV database, we identified consecutive ICU patients admitted between 2008 and 2022 who fulfilled Sepsis-3 criteria and had an SIC score ≥4. BAR was calculated from the 1st available laboratory values. Multivariable Cox regression and restricted cubic splines were used to estimate mortality associations after adjustment for demographics, comorbidities, interventions, severity scores (Sequential Organ Failure Assessment, Simplified Acute Physiology Score II), and laboratory parameters. The primary end-point was 30-day mortality; 90- and 365-day mortality were secondary. Among 4244 patients, higher admission BAR independently predicted increased mortality at 30, 90, and 365 days. Each 10-unit rise in BAR conferred a 30% higher hazard of death within 30 days (unadjusted hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.25-1.35; P < .001). After full adjustment, the association persisted (HR 1.18, 95% CI 1.12-1.24; P < .001). Similar patterns were seen for longer-term outcomes. A clear dose-response relationship was observed across BAR tertiles; patients in the highest tertile (BAR ≥ 10 mg/g) had markedly higher mortality risk (adjusted HR 1.69, 95% CI 1.43-2.00; P < .001) than those in the lowest. Nonlinear analysis revealed a curvilinear BAR-mortality relationship, and subgroup analyses showed consistent findings, with significant effect modification by age. In critically ill patients with SIC, an elevated admission BAR independently predicts short- and long-term mortality and may aid risk stratification and early intervention planning.

References

1. 1.Li, M., Wang, H., Wang, H., & Xu, Z. (2026). Association of blood urea nitrogen to serum albumin ratio with mortality in ICU patients with sepsis-induced coagulopathy: A Retrospective Cohort Study from MIMIC-IV database. Medicine, Article 0000000000048296. https://doi.org/10.1097/MD.0000000000048296