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CC BY-NC-ND 4.0 · Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-2274-0389
Article

Blood Urea Nitrogen to Serum Albumin Ratio as A New Prognostic Indicator in Critically Ill Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study

Tingting Hang   ‡
1   Department of Endocrinology, Changxing People’s Hospital, Huzhou, Zhejiang, China
,
Jing Huang   ‡
1   Department of Endocrinology, Changxing People’s Hospital, Huzhou, Zhejiang, China
,
Guiping He
1   Department of Endocrinology, Changxing People’s Hospital, Huzhou, Zhejiang, China
,
Jin Li
1   Department of Endocrinology, Changxing People’s Hospital, Huzhou, Zhejiang, China
,
Tingting Tao
1   Department of Endocrinology, Changxing People’s Hospital, Huzhou, Zhejiang, China
› Author Affiliations Funding information This work was supported by the National Natural Science Foundation of China (No:82200638) and the Medicine and Health Science and Technology Plan Program of Zhejiang Province (grant numbers: 2018263226).
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Abstract

Objective To investigate the predictive value of the blood urea nitrogen to serum albumin ratio for in-hospital and out-of-hospital mortality in critically ill patients with diabetic ketoacidosis.

Methods Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC III) database, and all eligible participants were categorized into two groups based on the BAR cutoff value. Multiple logistic regression analysis was conducted to determine the association between BAR and in-hospital mortality. The Kaplan–Meier (K–M) analysis was performed to evaluate the predictive performance of BAR. Propensity score matching (PSM) was applied to control confounding factors between the low and high BAR groups.

Results A total of 589 critically ill patients with diabetic ketoacidosis were enrolled. Patients with diabetic ketoacidosis with a higher BAR level were associated with higher in- and out-hospital mortality (all p<0.001). A significant 4-year survival difference was observed between the low and high BAR groups (p<0.0001). After PSM analysis, two PSM groups (202 pairs, n=404) were generated, and similar results were observed in the K–M curve (p<0.0001).

Discussion Elevated BAR levels were associated with an increased risk of in-hospital mortality in critically ill patients with diabetic ketoacidosis, and BAR could serve as an independent prognostic factor in in-hospital and out-of-hospital mortality for patients diagnosed with diabetic ketoacidosis.

Keywords

diabetic ketoacidosis - blood urea nitrogen - albumin - all-cause mortality - MIMIC-III database

‡ These authors contributed equally to this work: Tingting Hang, Jing Huang.


Zusätzliches Material



Publication History

Received: 14 June 2023
Received: 10 February 2024

Accepted: 22 February 2024

Accepted Manuscript online:
22 February 2024

Article published online:
10 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Umpierrez G, Korytkowski M. Diabetic emergencies – ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016; 12: 222-232
    Google Scholar
  • 2 Jensen ET, Stafford JM, Saydah S. et al. Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021; 44: 1573-1578
    Google Scholar
  • 3 Ramphul K, Joynauth J. An update on the incidence and burden of diabetic ketoacidosis in the U.S. Diabetes Care 2020; 43: e196-e197
    Google Scholar
  • 4 Yuyama Y, Kawamura T, Nishikawa-Nakamura N. et al. Relationship between bedside ketone levels and time to resolution of diabetic ketoacidosis: A retrospective cohort study. Diabetes Ther 2021; 12: 3055-3066
    Google Scholar
  • 5 Takahashi K, Anno T, Takenouchi H. et al. Serious diabetic ketoacidosis induced by insulin allergy and anti-insulin antibody in an individual with type 2 diabetes mellitus. J Diabetes Investig 2022; 13: 1788-1792
    Google Scholar
  • 6 Liu Q, Wang Y, Chen Z. et al. Age- and sex-specific reference intervals for blood urea nitrogen in Chinese general population. Sci Rep 2021; 11: 10058
    Google Scholar
  • 7 Maitland K. Management of severe paediatric malaria in resource-limited settings. BMC Med 2015; 13: 42
    Google Scholar
  • 8 Brar PC, Tell S, Mehta S. et al. Hyperosmolar diabetic ketoacidosis-- review of literature and the shifting paradigm in evaluation and management. Diabetes Metab Syndr 2021; 15: 102313
    Google Scholar
  • 9 Yao Y, Zhang P, Wang J. et al. Dissecting target toxic tissue and tissue specific responses of irinotecan in rats using metabolomics approach. Front Pharmacol 2017; 8: 122
    Google Scholar
  • 10 Eckart A, Struja T, Kutz A. et al. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: A prospective study. Am J Med 2020; 133: 713.e7-722.e7
    Google Scholar
  • 11 Bae SJ, Kim K, Yun SJ. et al. Predictive performance of blood urea nitrogen to serum albumin ratio in elderly patients with gastrointestinal bleeding. Am J Emerg Med 2021; 41: 152-157
    Google Scholar
  • 12 Huang D, Yang H, Yu H. et al. Blood urea nitrogen to serum albumin ratio (BAR) predicts critical illness in patients with coronavirus disease 2019 (COVID-19). Int J Gen Med 2021; 14: 4711-4721
    Google Scholar
  • 13 Zhao D, Liu Y, Chen S. et al. Predictive value of blood urea nitrogen to albumin ratio in long-term mortality in intensive care unit patients with acute myocardial infarction: A propensity score matching analysis. Int J Gen Med 2022; 15: 2247-2259
    Google Scholar
  • 14 Johnson AE, Pollard TJ, Shen L. et al. MIMIC-III, a freely accessible critical care database. Sci Data 2016; 3: 160035
    Google Scholar
  • 15 Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism 2016; 65: 507-521
    Google Scholar
  • 16 Wang ZH, Kihl-Selstam E, Eriksson JW. Ketoacidosis occurs in both Type 1 and Type 2 diabetes--a population-based study from Northern Sweden. Diabet Med 2008; 25: 867-870
    Google Scholar
  • 17 Miller KM, Foster NC, Beck RW. et al. Current state of type 1 diabetes treatment in the U.S.: Updated data from the T1D Exchange clinic registry. Diabetes Care 2015; 38: 971-978
    Google Scholar
  • 18 Benoit SR, Hora I, Pasquel FJ. et al. Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006-2015. Diabetes Care 2020; 43: 1057-1064
    Google Scholar
  • 19 Gregg EW, Hora I, Benoit SR. Resurgence in diabetes-related complications. JAMA 2019; 321: 1867-1868
    Google Scholar
  • 20 Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: A prospective study in a tertiary care hospital. J Clin Diagn Res 2015; 9: OC01-OC04
    Google Scholar
  • 21 Shaltout AA, Channanath AM, Thanaraj TA. et al. Ketoacidosis at first presentation of type 1 diabetes mellitus among children: A study from Kuwait. Sci Rep 2016; 6: 27519
    Google Scholar
  • 22 Su D, Li J, Guo M. et al. Clinical analysis of electrolyte disorders in patients with diabetic ketoacidosis. Clin Lab 2021; 67
    Google Scholar
  • 23 Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009; 20: 831-834
    Google Scholar
  • 24 Chen PK, Shih CC, Lin FC. et al. Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep 2019; 9: 9539
    Google Scholar
  • 25 Shen R, Gao M, Tao Y. et al. Prognostic nomogram for 30-day mortality of deep vein thrombosis patients in intensive care unit. BMC Cardiovasc Disord 2021; 21: 11
    Google Scholar
  • 26 Lu HY, Ning XY, Chen YQ. et al. Predictive value of serum creatinine, blood urea nitrogen, uric acid, and β(2)-microglobulin in the evaluation of acute kidney injury after orthotopic liver transplantation. Chin Med J 2018; 131: 1059-1066
    Google Scholar
  • 27 Khoury J, Bahouth F, Stabholz Y. et al. Blood urea nitrogen variation upon admission and at discharge in patients with heart failure. ESC Heart Fail 2019; 6: 809-816
    Google Scholar
  • 28 Bendardaf R, Bhamidimarri PM, Al-Abadla Z. et al. Ferritin, blood urea nitrogen, and high chest CT score determines ICU admission in COVID-19 positive UAE patients: A single center retrospective study. PLoS One 2022; 17: e0269185
    Google Scholar
  • 29 Bae JC, Seo SH, Hur KY. et al. Association between serum albumin, insulin resistance, and incident diabetes in nondiabetic subjects. Endocrinol Metab 2013; 28: 26-32
    Google Scholar
  • 30 Cheng PC, Hsu SR, Cheng YC. Association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus. J Diabetes Res 2016; 2016: 1269706
    Google Scholar
  • 31 Ugajin M, Yamaki K, Iwamura N. et al. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med 2012; 5: 583-589
    Google Scholar
  • 32 Fang J, Xu B. Blood urea nitrogen to serum albumin ratio independently predicts mortality in critically Ill patients with acute pulmonary embolism. Clin Appl Thromb Hemost 2021; 27 10760296211010241
    Google Scholar
  • 33 Lin Z, Zhao Y, Xiao L. et al. Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in critical patients with chronic heart failure. ESC Heart Fail 2022; 9: 1360-1369
    Google Scholar