Prognosis role of blood urea nitrogen to serum albumin ratio established in IPAH

A higher ratio of blood urea nitrogen to serum albumin is indicative of worse outcomes and disease severity in patients with idiopathic pulmonary arterial hypertension (IPAH), according to a study.

In the study, researchers explored the associations of blood urea nitrogen to serum albumin ratio (BAR) with functional status, echocardiographic findings, haemodynamics, and long-term outcomes among 340 patients with IPAH who underwent right heart catheterization.

The primary endpoint was the worsening of clinical symptoms. Spearman correlation coefficients, Kaplan–Meier analysis, and Cox proportional hazard models were used in the analysis, with receiver operating characteristic (ROC) curve applied to determine BAR’s optimal cutoff and predictive performance.

BAR was associated with well-established indicators of IPAH severity, including the World Health Organization functional class, 6-min walk distance, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, mixed venous oxygen saturation, and cardiac index.

On Kaplan–Meier curves, a BAR of >3.80 enabled the identification of patients with significantly higher clinical worsening rate (log-rank test, p<0.001).

In multivariable Cox models, BAR was an independent predictor of clinical worsening (hazard ratio, 1.177, 95 percent confidence interval, 1.014–1.367; p=0.005). Additionally, BAR improved the predictive value of the European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk assessment score.