Bridging the gap between biomarkers and bedside decisions: the prognostic value of the blood urea nitrogen-to-
Sepsis-associated acute kidney injury (AKI) is a leading cause of mortality in intensive care units, and identifying high-risk patients remains clinically challenging. Traditional severity scores often fail to capture dy
BackgroundWhile sepsis-associated acute kidney injury (AKI) is a leading cause of mortality in intensive care units, identifying high-risk patients remains clinically challenging. Traditional severity scores often fail to capture dynamic metabolic disturbances. This study aimed to characterize the association between the blood urea nitrogen-to-albumin ratio (BAR)—a novel biomarker reflecting systemic nitrogen metabolism and nutritional status—and 28-day mortality in patients with sepsis-associated AKI undergoing continuous renal replacement therapy (CRRT).
MethodsThis prospective observational study included 790 patients with sepsis-associated AKI undergoing CRRT. log2BAR was evaluated as a candidate prognostic variable. Multivariable Cox proportional hazard regression models were used to determine the association with 28-day mortality. The dose–response relationship was characterized by restricted cubic splines (RCS).
ResultsMultivariable analysis identified log2BAR as an independent predictor of 28-day mortality (adjusted HR = 1.33, 95% CI: 1.15~1.53, P < 0.001). RCS analysis revealed a significant dose–response relationship, with mortality risk increasing monotonically with log2BAR.
Conclusionslog2BAR is a robust and independent predictor of 28-day mortality in patients with sepsis-associated AKI treated with CRRT. Integrating this readily available biomarker provides valuable prognostic precision, supporting its use as a supplementary prognostic tool for early risk stratification in critically ill patients.