{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:00:07Z","timestamp":1790658007749,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic value of the urea\u2010to\u2010creatinine ratio in critically ill adults may vary according to the timing of measurement and baseline acute kidney injury status. We hypothesized that higher urea\u2010to\u2010creatinine ratios measured on study Days 1 and 7 would be associated with higher 28\u2010day mortality, and that these associations would differ according to baseline acute kidney injury status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a post hoc analysis of the multicenter cluster\u2010randomized trial. The urea\u2010to\u2010creatinine ratio was measured on study Days 1 and 7 (mmol\/mmol). Restricted cubic spline\u2010adjusted Cox models assessed associations between the urea\u2010to\u2010creatinine ratio and time to death through Day 28 in the overall population and according to baseline acute kidney injury status. Multivariable linear regression identified factors associated with Day 7 urea\u2010to\u2010creatinine ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Day 1 and Day 7 analyses included 2613 and 2516 patients, respectively. The urea\u2010to\u2010creatinine ratio was higher on Day 7 than on Day 1 and lower in patients with baseline acute kidney injury than in those without baseline acute kidney injury. No clear association was observed between the Day 1 urea\u2010to\u2010creatinine ratio and 28\u2010day mortality in the overall population or after stratification by baseline acute kidney injury status. The Day 7 urea\u2010to\u2010creatinine ratio was associated with 28\u2010day mortality in the overall population and showed a U\u2010shaped association in patients without baseline acute kidney injury, whereas no clear association was observed in patients with baseline acute kidney injury. In the Day 7 cohort without baseline acute kidney injury, low and high urea\u2010to\u2010creatinine ratio cohorts had higher mortality than the middle urea\u2010to\u2010creatinine ratio cohort, with adjusted hazard ratios of 2.06 (95% confidence interval, 1.30\u20133.26) and 2.21 (95% confidence interval, 1.45\u20133.38), respectively. Higher protein delivery and older age were associated with higher Day 7 urea\u2010to\u2010creatinine ratio, whereas baseline acute kidney injury, male sex, and higher body mass index were associated with lower Day 7 urea\u2010to\u2010creatinine ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No clear association between the Day 1 urea\u2010to\u2010creatinine ratio and 28\u2010day mortality was observed in the overall population or after stratification by baseline acute kidney injury status. On Day 7, the urea\u2010to\u2010creatinine ratio was associated with 28\u2010day mortality, with a U\u2010shaped association in patients without baseline acute kidney injury but no clear association in patients with baseline acute kidney injury. The urea\u2010to\u2010creatinine ratio should be interpreted cautiously in patients with acute kidney injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpen.70148","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:50:17Z","timestamp":1790657417000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Urea\u2010to\u2010Creatinine\u2010Ratio and the risk of 28\u2010day mortality in critically ill adults with or without Acute Kidney Injury: A post\u2010hoc analysis of a randomized clinical trial"],"prefix":"10.1002","author":[{"given":"Lingliang","family":"Zhou","sequence":"first","affiliation":[{"name":"School of Medicine Southeast University Nanjing China"},{"name":"Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangcheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University Huai'an Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Medicine Southeast University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufeng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of critical care medicine, Zhongda Hospital, Affiliated Hospital of Medical School Southeast University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur Raymond Hubert van","family":"Zanten","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Gelderse Vallei Hospital Ede The Netherlands"},{"name":"Division of Human Nutrition and Health Wageningen University &amp; Research Wageningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjian","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-5073","authenticated-orcid":false,"given":"Lu","family":"Ke","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8483-6264","authenticated-orcid":false,"given":"Weiqin","family":"Li","sequence":"additional","affiliation":[{"name":"School of Medicine Southeast University Nanjing China"},{"name":"Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Chinese Critical Care Nutrition Trials Group (CCCNTG)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"15","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"Puthucheary ZA","year":"2013","journal-title":"JAMA"},{"issue":"1","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13054-022-04253-0","article-title":"The rate and assessment of muscle wasting during critical illness: a systematic review and meta\u2010analysis","volume":"27","author":"Fazzini B","year":"2023","journal-title":"Crit Care"},{"issue":"4","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","article-title":"ICU\u2010acquired weakness","volume":"46","author":"Vanhorebeek I","year":"2020","journal-title":"Intensive Care Med"},{"issue":"17","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1056\/NEJMra1209390","article-title":"ICU\u2010acquired weakness and recovery from critical illness","volume":"370","author":"Kress JP","year":"2014","journal-title":"N Engl J Med"},{"issue":"1","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s13054-015-0993-7","article-title":"Clinical review: Intensive care unit acquired weakness","volume":"19","author":"Hermans G","year":"2015","journal-title":"Crit Care"},{"issue":"7","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1097\/CCM.0000000000005520","article-title":"REDOX REDUX? 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