Exploring the Blood Urea Nitrogen-to-Albumin Ratio: Insights into Three-M Relationship and Health Implications
Introduction
Table of Contents
Stroke is a major global health issue, being the second leading cause of death and the third leading cause of disability worldwide. Ischemic stroke accounted for 62.4% of all newly diagnosed strokes in 2019, emphasizing its prevalence in cerebrovascular disorders. The economic burden of stroke is significant, especially in low- and middle-income countries. To mitigate this burden, identifying high-risk patients in the acute phase of stroke is crucial for improving treatment and care during hospitalization. Research has shown that certain clinical biomarkers, like natriuretic peptides and cortisol, relate to acute ischemic stroke (AIS) prognosis. However, these biomarkers are not standard or easily accessible, prompting the search for simpler indicators. This study explores the BUN/Alb ratio as a potential predictor for adverse outcomes (AOs) in AIS cases after three months.
Materials and Methods
Study Design
This cohort study collected data from a prospective registry in South Korea from January 2010 to December 2016. The study focused on the BUN/Alb ratio as the main variable, with the outcome being the 3-month clinical outcomes of AIS cases.
Study Population
Data were collected from 2084 AIS cases admitted within seven days of symptom onset. Exclusion criteria included cases without necessary tests or scores recorded within 24 hours of admission, those lacking follow-up mRS scores at three months, and patients with end-stage renal failure. The final analysis included 1850 cases.
Variables
The BUN/Alb ratio was calculated by dividing serum BUN concentration (mg/dL) by serum Alb concentration (g/dL), creating a continuous variable that was categorized into quartiles. Three-month outcomes were measured using the modified Rankin Scale (mRS).
Statistical Analysis
Statistical analyses included descriptive statistics for continuous variables, chi-square tests, ANOVA, and Kruskal-Wallis tests for categorical variables. Univariate and multivariate logistic regression analyses assessed the relationship between the BUN/Alb ratio and AOs, considering factors like age, sex, and clinical features. Sensitivity analyses evaluated the robustness of these findings.
Results
Participant Characteristics
After applying the exclusion criteria, the final cohort comprised 1850 participants. The characteristics of the participants are detailed in Table 1.
Incidence Rate of Adverse Outcomes
Out of the cohort, 527 participants experienced AOs, reflecting an incidence rate of 28.49%. The rates were stratified by BUN/Alb quartiles, with the highest incidence (37.23%) observed in Quartile 4.
Univariate and Multivariate Analysis
Univariate analysis highlighted significant associations between higher BUN/Alb ratios and AOs. Multivariate analysis further confirmed a 15% increased risk of AOs for each unit increase in the BUN/Alb ratio.
Sensitivity Analysis
Sensitivity analysis, excluding cases with various conditions, showed that the previously noted relationship between the BUN/Alb ratio and AOs remained statistically insignificant in certain subgroups.
Nonlinearity Analysis
Using advanced statistical methods revealed a J-shaped relationship between the BUN/Alb ratio and AOs. This finding indicated a turning point at a BUN/Alb ratio of 2.86, where lower levels reduced AO risk.
Discussion
This study involved 2084 AIS cases and provides insight into the relationship between the BUN/Alb ratio and AOs at three months. The findings establish a J-shaped correlation, with a threshold at 2.86. Below this level, AOs decrease, while levels above it increase the risk. The BUN/Alb ratio is a promising, straightforward biomarker for prognosis in stroke management.
Conclusion
The study concludes that a lower BUN/Alb ratio may indicate fewer adverse outcomes in AIS patients. Monitoring this ratio can help identify high-risk patients, guiding treatment and improving functional outcomes.
Acknowledgments
Appreciation is extended to the authors of the original study for their contributions to this secondary analysis.
All authors declare no conflicts of interest. Funding sources are acknowledged appropriately.
References
A list of relevant studies and findings concerning stroke, BUN/Alb ratios, and associated mortality rates follows, including multiple studies that validate the findings and provide further context.
This format creates clear, concise content that communicates essential information about stroke prognosis and the significance of the BUN/Alb ratio in an understandable manner.