Bing Feng, Zhen Su, Bing Chen
This study aimed to investigate the prognostic value of the blood urea nitrogen-to-albumin ratio (BAR) for predicting all-cause mortality (ACM) in patients septic cardiomyopathy (SCM). An external validation was conducted in SCM patients from the Affiliated Hospital of Chengde Medical University. The results demonstrated that a higher BAR was significantly related to an increased sequential organ failure assessment (SOFA) score, a greater number of comorbidities, and worse clinical outcomes. Multiple regression analysis revealed that each unit increase in BAR was associated with a 4.1% rise in short-term mortality (OR = 1.041, P =0.04). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for BAR in predicting in-hospital mortality was < 0. 657, which was superior to that of blood urea nitrogen (BUN) alone or the SOFA score. In subgroup analyses, BAR remained stronger predictive ability in patients without any other comorbidities, such as renal insufficiency. In conclusion, BAR is an independent factor associated with short-term mortality in patients with SCM. As an easily accessible and broadly applicable marker reflecting both renal function and nutritional status, BAR may serve as a useful supplementary parameter for early risk stratification and medical treatment of patients with SCM. Receiver operating characteristic (ROC) analysis showed that BAR had modest discrimination for in-hospital mortality, with an AUC of 0.657 in the derivation cohort. Although this value was numerically higher than that of BUN alone and the SOFA score in the primary cohort, its overall discriminative ability remained limited. In the external validation cohort, BAR showed lower but still directionally consistent prognostic performance, with an AUC of 0.583. These findings suggest that BAR may serve as a simple and readily available supplementary marker for early risk stratification in patients with SCM, but it should not be interpreted as a stand-alone prognostic tool or a replacement for comprehensive clinical assessment. Multivariable regression analysis showed that each one-unit increase in BAR was associated with a higher risk of in-hospital mortality after full adjustment (OR = 1.041, 95% CI: 1.000-1.081, P = 0.04). However, the associations between BAR and 7-day, 30-day, and 365-day mortality after ICU discharge were attenuated and were no longer statistically significant in the fully adjusted model. These findings suggest that BAR is independently associated with in-hospital mortality in patients with SCM, whereas its relationship with post-ICU mortality should be interpreted as exploratory.