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OBJECTIVE: To investigate the predictive power of the BUN/albumin ratio (BAR) measured in the emergency department (ED) for the requirement of renal replacement therapy (RRT) in patients admitted to the intensive care unit (ICU) with severe COVID-19 pneumonia and acute kidney injury (AKI). MATERIALS AND METHODS: The study included 117 patients with AKI who were admitted to the ICU and had COVID-19 pneumonia detected on chest computed tomography (CT) taken in the ED's pandemic area between November 1, 2020, and June 1, 2021. The predictive power of laboratory values measured at the time of ED admission for the requirement of RRT was analyzed. RESULTS: Of the patients, 59.8% (n = 70) were male, with an average age of 71.7 ± 14.8 years. The mortality rate of the study was 35% (n = 41). During follow-up, 23.9% (n = 28) of the patients required RRT. Laboratory parameters measured at the time of ED admission showed that patients who required RRT had significantly higher BAR, BUN, and creatinine levels, and significantly lower albumin levels (all p < 0.001). ROC analysis to determine the predictive characteristics for RRT requirement revealed that the BAR had the highest AUC value (AUC, 0.885; 95% CI 0.825-0.945; p < 0.001). According to the study data, for BAR, a cut-off value of 1.7 resulted in a sensitivity of 96.4% and a specificity of 71.9%. CONCLUSION: In patients with severe pneumonia who develop acute kidney injury, the BUN/albumin ratio may guide clinicians early in predicting the need for renal replacement therapy.
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BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic was associated with a high mortality rate. It posed a formidable challenge to healthcare systems worldwide. In this study, we evaluated the predictive value of the blood urea nitrogen (BUN)/albumin ratio as a mortality marker in patients with moderate to severe COVID-19 infection in the emergency department (ED). METHODOLOGY: A retrospective evaluation of 352 patients with moderate to severe COVID-19 infections was conducted. Out of the 352 patients, 183 (51.99%) were discharged and 169 (48.01%) succumbed. Comprehensive demographic, clinical, biochemical, and haematological data was compiled for each patient. BUN to albumin ratios were determined for all patients, and all data were compared between survivors and non-survivors. RESULTS: This study included 352 patients. The average length of stay in the hospital was 13 days. In the survivor group, the median BAR value was 0.012, but in the non-survivor group, it was 0.022 (p > 0.001). Also, it was determined that the differences in creatinine, BUN, and albumin between the two groups were statistically significant. The median BAR value was significantly higher in the non-survivor group (0.022 [0.014-0.033]) as opposed to the survivor group. Also, the median values of creatinine were higher and albumin was lower in the non-survivor group. This difference was statistically significant. CONCLUSION: The BUN/albumin ratio can be utilized as a marker of mortality in patients with COVID-19 infection presenting to the emergency department.
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INTRODUCTION: The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. PATIENTS AND METHODS: The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. RESULTS: The study included 785 patients, 68% of whom were male and the mean age was 67±16 (18-92). The median duration of follow-up was 61.2±11.8 (37-90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8±4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. CONCLUSION: Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients.