Blood urea nitrogen to albumin ratio as a robust predictor of in-hospital mortality in patients with predicted severe acute pancreatitis: a retrospective multicenter observational study

作者：Maobin Kuang, Yaoyu Zou, Yuting Lei, Cong He, Nianshuang Li, Ling Ding, Huijie Zhang, Yupeng Lei, Xin Huang, Huifang Xiong, Lingyu Luo, Liang Xia, Wenhua He, Nonghua Lv, Wenjian Mao, Lu Ke, Yin Zhu · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000003553 · 被引用次数：5 · 研究领域：Pancreatitis Pathology and Treatment、Sepsis Diagnosis and Treatment、Acute Kidney Injury Research

BACKGROUND: Despite the established role of blood urea nitrogen-to-albumin ratio (BAR) in critical care, its prognostic value in acute pancreatitis remains unvalidated. This multicenter study assessed BAR's accuracy as an admission biomarker for predicting in-hospital mortality in predicted severe acute pancreatitis (SAP) cases. METHODS: This retrospective study enrolled 5384 patients from the LOCAL cohort and 494 patients from a multicenter double-blind randomized controlled trial (TRACE cohort), all of whom were predicted to have SAP (APACHE II ≥8) upon admission. Cox regression models were employed in two independent cohorts to explore the association between BAR and the risk of in-hospital mortality in subjects, and a restricted cubic spline regression was further constructed. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve was determined to evaluate the predictive capacity of BAR, blood urea nitrogen (BUN), albumin (ALB) and traditional scoring systems (APACHE II, SIRS, and BISAP) for in-hospital mortality. Time-dependent ROC analysis was also performed to assess the predictive performance of BUN and BAR at multiple time points. RESULTS: In the LOCAL and TRACE cohorts, 320 (5.94%) and 39 (7.89%) patients died during hospitalization, respectively. Multivariable Cox regression models showed a significant positive association between BAR and the risk of in-hospital mortality [HR: LOCAL 1.23 (1.16-1.31); TRACE 1.33 (1.01-1.76)], whil...