Prediction of prognosis in patients with nontraumatic intracranial hemorrhage using blood urea nitrogen-to-creatinine ratio on admission: a retrospective cohort study based on data from the medical information Mart for intensive care-IV database

Peng Chen; YongAn Jiang; JiaHong Cai; Heng Yi Fan; JiaWei Liang; RaoRao Yuan; Hao Wu; YongHong Wang; ShiQi Cheng; Yan Zhang

doi:10.3389/fneur.2023.1267815

Prediction of prognosis in patients with nontraumatic intracranial hemorrhage using blood urea nitrogen-to-creatinine ratio on admission: a retrospective cohort study based on data from the medical information Mart for intensive care-IV database

Front Neurol. 2024 Jan 5:14:1267815. doi: 10.3389/fneur.2023.1267815. eCollection 2023.

Authors

Peng Chen^#¹, YongAn Jiang^#¹, JiaHong Cai^#¹, Heng Yi Fan¹, JiaWei Liang¹, RaoRao Yuan¹, Hao Wu², YongHong Wang², ShiQi Cheng¹, Yan Zhang¹

Affiliations

¹ Department of Neurosurgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
² Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.

^# Contributed equally.

Abstract

Background: The blood urea nitrogen-to-creatinine ratio (BUNCR) has been proposed as a potential biomarker for critical illness-induced catabolism. However, its specific relevance and significance in the context of non-traumatic intracranial hemorrhage (NTIH) remains unclear. As such, the primary objective of this study was to determine the role of BUNCR in the prognosis of patients with NTIH.

Materials and methods: All data were sourced from the Medical Information Mart for Intensive Care-IV 2.0 (MIMIC-IV) database. Study outcomes included 30-day and 1-year mortality rates. Univariate and multivariate logistic regression analyses were used to calculate adjusted odds ratio with corresponding 95% confidence interval, and generalized additive model were used to identify both linear and non-linear relationships between BUNCR and mortality rates. A two-piecewise regression model was performed to calculate the saturation effect. Subgroup analyses were performed to evaluate outcome stability in various groups.

Results: A retrospective study of 3,069 patients with NTIH revealed a U-shaped relationship between BUNCR levels and 30-day/1-year mortality. The two-piecewise regression model showed that the inflection points for 30-day and 1-year mortality were 10.455 and 16.25, respectively. On the left side of the inflection point, the 30-day and 1-year mortality rate decreased by 17.7% (OR = 0.823, 95%CI: 0.705-0.960; p = 0.013) and 5.3% (OR = 0.947, 95%CI: 0.899-0.999; p = 0.046), respectively, per 1 unit increment of BUNCR. On the right side of the inflection point, the 30-day and 1-year mortality rate increased by 1.6% (OR = 1.016, 95%CI: 1.000-1.031; p = 0.046) and 3.6% (OR = 1.036, 95%CI:1.019-1.054; p < 0.001) per 1 unit decrement of BUNCR. Subgroup analyses revealed consistent results across different strata.

Conclusion: This study identified a nonlinear relationship between BUNCR and mortality in patients with NTIH, indicating that BUNCR may be valuable prognostic marker for early identification and proactive management.

Keywords: U-shaped curve; creatinine; mortality; nontraumatic intracranial hemorrhage; urea nitrogen.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the National Natural Science Foundation (Grant nos. 82260378 and 82260388) and Internal Funding Project of the Second Affiliated Hospital of Nanchang University (Grant no. 2021efyC09).