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Original Research

Open Access Special Issue

Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke

  • Sung Jin Bae1
  • Sun Hwa Lee2
  • Seong Jong Yun3
  • Keon Kim4

1Department of Emergency Medicine, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea

2Ewha Womans University Mokdong Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea

3Department of Radiology, G SAM hospital, 591 Gunpo-ro, Gunpo-si, Gyeonggi-do, 15839, Republic of Korea

4Ewha Womans University Seoul Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea

DOI: 10.22514/sv.2021.028 Vol.17,Issue 4,July 2021 pp.163-170

Submitted: 05 January 2021 Accepted: 26 January 2021

Published: 08 July 2021

*Corresponding Author(s): Keon Kim E-mail: mikky5163@gmail.com

Abstract

Objectives: Acute ischemic stroke (AIS) is one of the most important and major causes of mortality worldwide. In AIS patients, the blood urea nitrogen to creatinine ratio (B/C ratio) was investigated as a dehydrated biomarker in previous studies. However, the B/C ratio can be affected by medications and past medical history. We hypothesized addition of serum albumin, which has been shown to have beneficial neuroprotective effects, could compensate for the disadvantages. In the present study, the BUN to serum albumin ratio (B/A ratio) was evaluated association with AIS patient’s prognosis.

Methods: This retrospective cohort study of AIS in our hospital was conducted from February 2018 through June 2020. First, demographic and clinical data were collected and compared with the prevalence of mortality and ICU admission. Then, the B/C ratio and the B/A ratio were calculated. Differences in the performance between the B/C ratio and the B/A ratio for outcome prediction were evaluated based on the area under the curve of the receiver operating characteristic (AUROC).

Results: Among the 1,164 patients enrolled in this study, 77 (6.6%) died during hospitalization and 467 (40.1%) were admitted to ICU. Multivariate logistic regression had shown that the B/A ratio was a significant predictor of mortality and admission to ICU. In addition, the B/A ratio was significantly higher in ICU-admitted patients and non-survivors. The AUROC of the B/A ratio was 0.687 and the B/C ratio was 0.533 for predicting mortality; the B/A ratio was statistically superior to the B/C ratio. For predicting ICU admission, the AUROC values of the B/A ratio and the B/C ratio were 0.567 and 0.556, respectively, and a statistically significant difference was not observed.

Conclusion: The B/A ratio is a simple and useful tool for predicting the outcomes of ischemic stroke patients.


Keywords

Stroke; Blood urea nitrogen; Albumin; Mortality; Intensive care unit; Emergency department


Cite and Share

Sung Jin Bae,Sun Hwa Lee,Seong Jong Yun,Keon Kim. Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke. Signa Vitae. 2021. 17(4);163-170.

References

[1] Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018; 137: e67-e492.

[2] Bhaskar S, Stanwell P, Cordato D, Attia J, Levi C. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurology. 2018; 18: 8.

[3] Wang G, Zhang Z, Ayala C, Dunet DO, Fang J, George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. Journal of Stroke and Cerebrovascular Diseases. 2014; 23: 861-868.

[4] Thanvi B, Treadwell S, Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgraduate Medical Journal. 2008; 84: 412-417.

[5] Siegler JE, Martin-Schild S. Early Neurological Deterioration (END) after stroke: the END depends on the definition. International Journal of Stroke. 2011; 6: 211-212.

[6] Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complica-tions of endovascular treatment for acute ischemic stroke: prevention and management. International Journal of Stroke. 2018; 13: 348-361.

[7] Adams HP, Davis PH, Leira EC, Chang K-, Bendixen BH, Clarke WR, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999; 53: 126-131.

[8] Meyer BC, Hemmen TM, Jackson CM, Lyden PD. Modified National Institutes of Health Stroke Scale for use in stroke clinical trials: prospective reliability and validity. Stroke. 2002; 33: 1261-1266.

[9] Schrock JW, Glasenapp M, Drogell K. Elevated blood urea nitro-gen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clinical Neurology and Neurosurgery. 2012; 114: 881-884.

[10] Deng L, Wang C, Qiu S, Bian H, Wang L, Li Y, et al. Association between blood urea nitrogen-to-creatinine ratio and three-month outcome in patients with acute ischemic stroke. Current Neurovascular Research. 2019; 16: 166-172.

[11] Ginsberg MD, Palesch YY, Hill MD, Martin RH, Moy CS, Barsan WG, et al. High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial. The Lancet Neurology. 2013; 12: 1049-1058.

[12] Chen J, Fredrickson V, Ding Y, Cheng H, Wang N, Ling F, et al. Enhanced neuroprotection by local intra-arterial infusion of human albumin solution and local hypothermia. Stroke. 2013; 44: 260-262.

[13] Zhang Q, Lei Y, Wang Q, Jin Y, Fu R, Geng H, et al. Serum albumin level is associated with the recurrence of acute ischemic stroke. The American Journal of Emergency Medicine. 2016; 34: 1812-1816.

[14] Babu MS, Kaul S, Dadheech S, Rajeshwar K, Jyothy A, Munshi A. Serum albumin levels in ischemic stroke and its subtypes: correlation with clinical outcome. Nutrition. 2013; 29: 872-875.

[15] Ryu S, Oh SK, Cho SU, You Y, Park JS, Min JH, et al. Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients. The American Journal of Emergency Medicine. 2020; S0735-6757(20)30118-2.

[16] Viasus D, Garcia-Vidal C, Simonetti A, Manresa F, Dorca J, Gudiol F, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. The Journal of Infection. 2014; 66: 415-423.

[17] Hajian-Tilaki K. Receiver Operating Characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian Journal of Internal Medicine. 2013; 4: 627-635.

[18] Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. American Journal of Epidemiology. 2006; 163: 670-675.

[19] Zou X, Feng D, Wu W, Yang H, Zhang T. Blood urea nitrogen to serum albumin ratio independently predicts 30-day mortality and severity in patients with Escherichia coli bacteraemia. Medicina ClíNica. 2020; S0025-7753(20)30638-2. (In Spanish)

[20] Akahane J, Ushiki A, Kosaka M, Ikuyama Y, Matsuo A, Hachiya T, et al. Blood urea nitrogen-to-serum albumin ratio and a-DROP are useful in assessing the severity of pneumocystis pneumonia in patients without human immunodeficiency virus infection. Journal of Infection and Chemotherapy. 2020; S1341-321X(20)30452-9.

[21] Putaala J, Haapaniemi E, Gordin D, Liebkind R, Groop P, Kaste M, et al. Factors associated with impaired kidney function and its impact on long-term outcome in young ischemic stroke. Stroke. 2011; 42: 2459-2464.

[22] Kim J, Song TJ, Song D, Yoo J, Baek JH, Lee HS, et al. Prognostic value of urine dipstick proteinuria on mortality after acute ischemic stroke. Atherosclerosis. 2016; 253: 118-123.

[23] Ovbiagele B, Schwamm LH, Smith EE, Grau‐Sepulveda MV, Saver JL, Bhatt DL, et al. Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease. Journal of the American Heart Association. 2014; 3: e000905.

[24] You S, Zheng D, Zhong C, Wang X, Tang W, Sheng L, et al. Prognostic significance of blood urea nitrogen in acute ischemic stroke. Circulation Journal. 2019; 82: 572-578.

[25] González-Alonso J, Calbet JAL, Nielsen B. Muscle blood flow is reduced with dehydration during prolonged exercise in humans. The Journal of Physiology. 1998; 513: 895-905.

[26] Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. The American Journal of Medicine. 2004; 116: 466-473.

[27] Belayev L, Busto R, Zhao W, Clemens JA, Ginsberg MD. Effect of delayed albumin hemodilution on infarction volume and brain edema after transient middle cerebral artery occlusion in rats. Journal of Neurosurgery. 1997; 87: 595-601.

[28] Belayev L, Zhao W, Pattany PM, Weaver RG, Huh PW, Lin B, et al. Diffusion-weighted magnetic resonance imaging confirms marked neuroprotective efficacy of albumin therapy in focal cerebral ischemia. Stroke. 1998; 29: 2587-2599.

[29] Remmers M, Schmidt-Kastner R, Belayev L, Lin B, Busto R, Ginsberg MD. Protein extravasation and cellular uptake after high-dose human albumin treatment of transient focal cerebral ischemia in rats. Brain Research. 1999; 827: 237-242.

[30] Belayev L, Liu Y, Zhao W, Busto R, Ginsberg MD. Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke. 2001; 32: 553- 560.

[31] Djoussé L, Rothman KJ, Cupples LA, Levy D, Ellison RC. Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study. Circulation. 2002; 106: 2919-2924.

[32] Lionaki S, Derebail VK, Hogan SL, Barbour S, Lee T, Hladunewich M, et al. Venous thromboembolism in patients with membranous nephropathy. Clinical Journal of the American Society of Nephrology. 2012; 7: 43-51.

[33] Saeed F, Adil MM, Khursheed F, Daimee UA, Branch LA, Vidal GA,

et al. Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke: analysis of nationwide inpatient sample. Stroke. 2014; 45: 1478-1480.

[34] Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. The Lancet Neurology. 2014; 13: 823-833.

[35] Singh T, Astor BC, Waheed S. End-stage renal disease patients with low serum albumin: is peritoneal dialysis an option? Peritoneal Dialysis International. 2019; 39: 562-567.

[36] Minatoguchi S, Nomura A, Imaizumi T, Sasaki S, Ozeki T, Uchida D, et al. Low serum albumin as a risk factor for infection-related in-hospital death among hemodialysis patients hospitalized on suspicion of infectious disease: a Japanese multicenter retrospective cohort study. Renal Replacement Therapy. 2018; 4: 30.


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