Download PDF
CC BY 4.0 · Avicenna J Med 2023; 13(01): 043-048
DOI: 10.1055/s-0043-1761471
Original Article

Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients

Serdar Özdemir 
1   Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
,
İbrahim Altunok 
1   Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Hematological parameters and their ratios are the most studied biomarkers for prediction of mortality or severe illness in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to compare the power of the blood urea nitrogen (BUN)/albumin ratio, lactate/albumin ratio, and C-reactive protein (CRP)/albumin ratio, measured at the time of admission, in predicting 30-day mortality in SARS-CoV-2-infected patients presenting to the emergency department (ED).

Materials and Methods This retrospectively designed, single-center, observational study was performed in the ED of a tertiary education health care center. We documented the data of patients admitted with a confirmed SARS-CoV-2 infection between September 1, 2020, and January 1, 2021.

Results Of the 470 patients included in the study, 232 (49.4%) were female. The all-cause 30-day mortality rate was 23.8%. The area under the curve values for the BUN/albumin ratio, lactate/albumin ratio, and CRP/albumin ratio in the prediction of 30-day mortality were 0.725, 0.641, and 0.749, respectively. Sensitivity and negative predictive value for CRP/albumin ratio (≥0.049) and specificity for BUN/albumin ratio (≥1.17) were 92.86, 94.9, and 71.23, respectively. The odds ratio values of the BUN/albumin ratio (≥1.17), CRP/albumin ratio (≥0.049), and lactate/albumin ratio (≥0.046) for 30-day mortality were determined as 4.886, 9.268, and 2.518, respectively.

Conclusion The BUN/albumin ratio and CRP/albumin ratio can be used to predict 30-day mortality in SARS-CoV-2-infected patients admitted to ED. Furthermore, CRP/albumin ratio had the highest sensitivity and negative predictive value, while BUN/albumin ratio had the highest specificity.

Keywords

biomarkers - albumin - C-reactive protein - SARS-CoV-2 - coronavirus disease 2019 - blood urea nitrogen


Publication History

Article published online:
23 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Eroglu SE, Aksel G, Altunok I. et al. Can Google® trends predict emergency department admissions in pandemic periods?. Med Sci (Turkey) 2021; 10 (01) 111-117 DOI: 10.5455/medscience.2020.08.162.
    CrossrefGoogle Scholar
  • 2 Sen-Crowe B, Sutherland M, McKenney M, Elkbuli A. A closer look into global hospital beds capacity and resource shortages during the COVID-19 pandemic. J Surg Res 2021; 260: 56-63
    CrossrefPubMedGoogle Scholar
  • 3 Awale RB, Singh A, Mishra P. et al. Routine hematology parameters in COVID-19: a predictor of disease severity and mortality. J Family Med Prim Care 2022; 11 (07) 3423-3429
    CrossrefPubMedGoogle Scholar
  • 4 Asan A, Üstündağ Y, Koca N. et al. Do initial hematologic indices predict the severity of COVID-19 patients?. Turk J Med Sci 2021; 51 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 5 Seyit M, Avci E, Nar R. et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. Am J Emerg Med 2021; 40: 110-114
    CrossrefPubMedGoogle Scholar
  • 6 Özdemir S, Algın A. Interpretation of the area under the receiver operating characteristic curve. Exp Appl Med Sci 2022; 3 (01) 310-311
    Google Scholar
  • 7 Szumilas M. Explaining odds ratios. J Can Acad Child Adolesc Psychiatry 2010; 19 (03) 227-229 Erratum in: J Can Acad Child Adolesc Psychiatry 2015; 24(1):58
    PubMedGoogle Scholar
  • 8 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 2021; 46: 349-354
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 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
    CrossrefPubMedGoogle Scholar
  • 11 Özdemir S, Akça HŞ, Algın A, Eroğlu SE. Can C-reactive protein-to-albumin ratio be a predictor of short-term mortality in community-acquired pneumonia?. Ann Clin Anal Med 2021; 12 (09) 1043-1048 DOI: 10.4328/ACAM.20576.
    CrossrefGoogle Scholar
  • 12 Güney BÇ, Taştan YÖ, Doğantekin B. et al. Predictive value of CAR for in-hospital mortality in patients with COVID-19 pneumonia: a retrospective cohort study. Arch Med Res 2021; 52 (05) 554-560
    CrossrefPubMedGoogle Scholar
  • 13 Torun A, Çakırca TD, Çakırca G, Portakal RD. The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of COVID-19. Rev Assoc Med Bras 2021; 67 (03) 431-436
    CrossrefPubMedGoogle Scholar
  • 14 Demir E, Giden R, Demir Giden Z. The relationship between C-reactive protein/albumin ratio and radiological findings in patients with COVID-19. J Contemp Med 2021; 11 (05) 627-630
    CrossrefGoogle Scholar
  • 15 Lichtenauer M, Wernly B, Ohnewein B. et al. The lactate/albumin ratio: a valuable tool for risk stratification in septic patients admitted to ICU. Int J Mol Sci 2017; 18 (09) 1893
    CrossrefPubMedGoogle Scholar
  • 16 Shin J, Hwang SY, Jo IJ. et al; Korean Shock Society (KoSS) Investigators. Prognostic value of the lactate/albumin ratio for predicting 28-day mortality in critically ill sepsis patients. Shock 2018; 50 (05) 545-550
    CrossrefPubMedGoogle Scholar
  • 17 Gök A, Kasapoğlu US, Acun Delen L, Özmen F, Banazılı S. Lactate/albumin ratio as a prognostic factor for short-time mortality in critically ill patients with coronavirus disease-2019. J Turk Soc Intens Care 2021; 19: 62-72 DOI: 10.4274/tybd.galenos.2021.37167.
    CrossrefGoogle Scholar