Introduction: We researched blood urea nitrogen (BUN), albumin and their ratio (BAR), and compared them with C-reactive protein (CRP), D-dimer, and computed tomography severity scores (CT-SS), to predict inhospital mortality. Methods: One-hundred and thirty-one coronavirus disease-2019 (COVID-19)-confirmed patients brought to the emergency department (ED) were dispensed to the survivor or non-survivor group, in light of inhospital mortality. Information on age, gender, complaints, comorbidities, laboratory parameters, and outcome were gathered from the patient's record files. Results: The median BUN, mean total protein, mean albumin, median BAR, median creatinine, median CRP, and median D-dimer were recorded. CT-SS were utilized in categorizing the patient as mild, moderate, and severe. Inhospital mortality occurred in 42 (32.06%) patients (non-survivor group) and did not occur in 89 (67.94%) patients (survivor group). The median BUN (mg/dL) and BAR (mg/g) values were significantly raised in the non-survivor group than in the survivor group [BUN: 23.48 (7.51–62.75) and 20.66 (4.07–74.67), respectively (p = 0.009); BAR: 8.33 mg/g (2.07–21.86) and 6.11 mg/g (1.26–23.33); (p = 0.0003)]. The mean albumin levels (g/dL) in the non-survivor group were significantly lower than in the survivor group [2.96 ± 0.35 and 3.27 ± 0.35, respectively (p <0.0001)]. Albumin with an odd's ratio of 6.14 performed the best in predicting inhospital mortality, followed by D-dimer (4.98). BAR and CRP had similar outcome of 3.75; BUN showed an OR of 3.13 at the selected cutoff value. Conclusion: The BUN, albumin, and BAR were found to be dependable predictors of inhospital mortality in COVID-19 patients, with albumin (hypoalbuminemia) performing even better.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. Journal of the American Medical Association 2020;323(13):1239–1242. DOI: 10.1001/jama.2020.2648.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58(5):377–382. DOI: 10.1136/thorax.58.5.377.
Wernly B, Lichtenauer M, Vellinga NAR, Boerma EC, Ince C, Kelm M, et al. Blood urea nitrogen (BUN) independently predicts mortality in critically ill patients admitted to ICU: a multicenter study. Clin Hemorheol Microcirc 2018;69(1–2):123–131. DOI: 10.3233/CH-189111.
Kazory A. Emergence of blood urea nitrogen as a biomarker of neurohormonal activation in heart failure. Am J Cardiol 2010;106(5):694–700. DOI: 10.1016/j.amjcard.2010.04.024.
Yang CJ, Chen J, Phillips AR, Windsor JA, Petrov MS. Predictors of severe and critical acute pancreatitis: a systematic review. Dig Liver Dis 2014;46(5):446–451. DOI: 10.1016/j.dld.2014.01.158.
Cheng A, Hu L, Wang Y, Huang L, Zhao L, Zhang C, et al. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. Int J Antimicrob Agents 2020;56(3):106110. DOI: 10.1016/j.ijantimicag.2020.106110.
Küçükceran K, Ayrancı MK, Girişgin AS, Koçak S, Dündar ZD. The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Am J Emerg Med 2021;48:33–37. ISSN 0735-6757. DOI: 10.1016/j.ajem.2021.03.090.
Ronit A, Kirkegaard-Klitbo DM, Dohlmann TL, Lundgren J, Sabin CA, Phillips AN, et al. Plasma albumin and incident cardiovascular disease: results from the CGPS and an updated meta-analysis. Arterioscler Thromb Vasc Biol 2020;40(2):473–482. DOI: 10.1161/ATVBAHA.119.313681.
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;71(15):762. DOI: 10.1093/cid/ciaa248.
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr 2019;43(2):181–193. DOI: 10.1002/jpen.1451.
Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y, et al. Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol 2020;92(10):2152–2158. DOI: 10.1002/jmv.26003.
Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F, et al. Is albumin predictor of mortality in COVID-19? Antioxid Redox Signal 2021;35(2):139–142. DOI: 10.1089/ars.2020.8142.
Dundar ZD, Kucukceran K, Ayranci MK. Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients. Am J Emerg Med 2020:S0735-6757(20)30892-5. DOI: 10.1016/j.ajem.2020.10.008.
Ryu S, Kwang Oh S, 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. Am J Emerg Med 2021;43:175–179. DOI: 10.1016/j.ajem.2020.02.045.
Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review. PLoS One 2020;15(11):e0241955. DOI: 10.1371/journal.pone.0241955.
Bajgain KT, Badal S, Bajgain BB, Santana MJ. Prevalence of comorbidities among individuals with COVID-19: a rapid review of current literature. Am J Infect Control 2021;49(2):238–246. DOI: 10.1016/j.ajic.2020.06.213.
Arihan O, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, et al. Blood urea nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU. PLoS One 2018;13(1):e0191697. DOI: 10.1371/journal.pone.0191697.
Metersky ML, Waterer G, Nsa W, Bratzler DW. Predictors of in-hospital vs post discharge mortality in pneumonia. Chest 2012;142(2):476–481. DOI: 10.1378/chest.11-2393.
Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from COVID-19. PLoS One 2020;15(7):e0235458. DOI: 10.1371/journal.pone.0235458.
Ambade V. Biochemical rationale for hypoalbuminemia in COVID-19 patients. J Med Virol 2021;93(3):1207–1209. DOI: 10.1002/jmv.26542.
Wada Y, Takeda Y, Kuwahata M. Potential role of amino acid/protein nutrition and exercise in serum albumin redox state. Nutrients 2017;10(1):17. DOI: 10.3390/nu10010017.
Mclntyre N, Rosalki S. Tests of the functions of the liver. In: Williams D, Marks V, editors. Scientific foundations of biochemistry in clinical practice. 2nd ed. Butterworth-Heinemann; 1994. p. 383–398.
Herlekar R, Sur Roy A, Matson M. Hypoalbuminaemia in COVID-19 infection: a predictor of severity or a potential therapeutic target? J Med Virol 2021;93(1):83–84. DOI: 10.1002/jmv.26151.
Feng DY, Zhou YQ, Zou XL, Zhou M, Yang HL, Chen XX, et al. Elevated blood urea nitrogen-to-serum albumin ratio as a factor that negatively affects the mortality of patients with hospital-acquired pneumonia. Can J Infect Dis Med Microbiol 2019:1547405. DOI: 10.1155/2019/1547405.
Huang D, Yang H, Yu H, Wang T, Chen Z, Liang Z, 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. DOI: 10.2147/IJGM.S326204.
Gemcioglu E, Davutoglu M, Catalbas R, Karabuga B, Kaptan E. Predictive values of biochemical markers as early indicators for severe COVID-19 cases in admission. Future Virol 2021;16(5):353–367. DOI: 10.2217/fvl-2020-0319.
Shang W, Dong J, Ren Y, Tian M, Li W, Hu J, Li Y. The value of clinical parameters in predicting the severity of COVID-19. J Med Virol 2020;92(10):2188–2192. DOI: 10.1002/jmv.26031.
Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, et al. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J Community Hosp Intern Med Perspect 2020;10(5):402–408. DOI: 10.1080/20009666.2020.1798141.
Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020;30(12):6808–6817. DOI: 10.1007/s00330-020-07033-y.
Kohli A, Jha T, Pazhayattil AB. The value of AI based CT severity scoring system in triage of patients with Covid-19 pneumonia as regards oxygen requirement and place of admission. Indian J Radiol Imag 2021;31(Suppl 1):S61–S69. DOI: 10.4103/ijri.IJRI_965_20.
Kwee TC, Kwee RM. Chest CT in COVID-19: what the radiologist needs to know. Radiographics 2020;40(7):1848–1865. DOI: 10.1148/rg.2020200159.