Clin Lab. 2026 Jun 1;72(6). doi: 10.7754/Clin.Lab.2025.250623.
ABSTRACT
BACKGROUND: Cardiogenic shock (CS) is a life-threatening condition with high mortality. This study explored the association between the blood urea nitrogen-to-albumin ratio (BAR), a marker of renal function and nutritional status, and mortality in CS, aiming to evaluate its utility as a simple early risk stratification tool.
METHODS: This study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, categorizing participants by BAR quartiles to examine 28-day intensive care unit (ICU) mortality. Least absolute shrinkage and selection operator (LASSO) regression was used to identify key variables associated with BAR and clinical outcomes. Logistic regression, Cox proportional hazards models, and restricted cubic splines were applied to assess the relationship between BAR and mortality. Kaplan-Meier curves illustrated cumulative mortality, while sensitivity and subgroup analyses were conducted to ensure the robustness of the findings. Causal mediation analysis (CMA) was conducted to investigate the indirect effects of BAR on prognosis.
RESULTS: This study of 1,474 CS patients found that a higher BAR was linked to a greater risk of 28-day ICU mortality. After adjustments, those in the highest BAR quartile had a significantly increased mortality risk (HR 1.88, 95% CI: 1.30 - 2.71, p = 0.001) compared to those in the lowest quartile. Kaplan-Meier analysis demonstrated significantly reduced 28-day ICU survival probabilities in highest BAR quartile. Hemoglobin partially mediated this relationship, explaining 10.88% of the effect. The association between BAR and prognosis in patients with CS remained consistent across most subgroups, with significant interactions identified in the race and acute kidney injury (AKI) subgroups.
CONCLUSIONS: This study found that elevated BAR is closely associated with adverse ICU outcomes in patients with CS.
PMID:42295314 | DOI:10.7754/Clin.Lab.2025.250623