{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:11:00Z","timestamp":1791216660780,"version":"4.1.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Blood urea nitrogen to albumin ratio (BAR) has served as a predictive marker for patients in the Intensive Care Unit (ICU), and has been studied in patients with sepsis, post-cardiac surgery, severe COVID-19, and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This objective indicator has demonstrated capability in prognostic prediction.However, research on the prognostic value of BAR in acute pancreatitis (AP) patients are scarce,the goal was to explore the relationship between BAR and total mortality in AP admitted to ICU.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A Retrospective analysis was performed utilizing the Medical Information Market for Intensive Care (MIMIC IV) database. Patients with AP admitted to ICU were included and grouped based on BAR. Univariate and multivariate Cox regression analysis were utilized to explore the relationship between BAR and total mortality. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was applied to assess the predictive value of BAR. Cumulative hazard risk accumulation curve verified BAR\u2019s predictive capability for short- and long-term mortality. Heterogeneity between different subgroups was excluded by subgroup analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Total 514 AP patients were divided into high-BAR (BAR\u2009\u2265\u20097.62) and low-BAR group (BAR\u2009&lt;\u20097.62). The duration of ICU stay was significantly extended in the high BAR group. In the Cox proportional hazard model, whether adjusting for confounding factors or not, the high BAR was an independent risk factor for total mortality. AUC for BAR was 0.78 (95% C1: 0.72\u20130.84) at 28 days and 0.70 (95%: Cl: 0.64\u20130.75) at 360 days.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>BAR is an objective and independent predictor of both short- and long-term total mortality in AP patients. A prompt, efficient, and uncomplicated assessment of the severity and prognosis, which facilitates ICU doctors to develop treatment plans for poor patient outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323321","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T17:50:32Z","timestamp":1747331432000},"page":"e0323321","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Blood urea nitrogen to albumin ratio as predictor of mortality among acute pancreatitis patients in ICU: A retrospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9646-1224","authenticated-orcid":true,"given":"Wei","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4203-1169","authenticated-orcid":true,"given":"Jun","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"issue":"20","key":"pone.0323321.ref001","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1056\/NEJMra1505202","article-title":"Acute Pancreatitis","volume":"375","author":"CE Forsmark","year":"2016","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0323321.ref002","doi-asserted-by":"crossref","DOI":"10.1053\/j.gastro.2018.04.013","article-title":"Nationwide trends in acute and chronic pancreatitis among privately insured children and non-elderly adults in the United States, 2007-2014","volume":"155","author":"Z Sellers","year":"2018","journal-title":"Gastroenterology"},{"issue":"3","key":"pone.0323321.ref003","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/MCG.0000000000001030","article-title":"Incidence, Admission Rates, and Predictors, and Economic Burden of Adult Emergency Visits for Acute Pancreatitis: Data From the National Emergency Department Sample, 2006 to 2012","volume":"53","author":"SK Garg","year":"2019","journal-title":"J Clin Gastroenterol"},{"issue":"9988","key":"pone.0323321.ref004","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0140-6736(14)60649-8","article-title":"Acute pancreatitis","volume":"386","author":"PG Lankisch","year":"2015","journal-title":"Lancet"},{"issue":"4","key":"pone.0323321.ref005","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute pancreatitis: a review","volume":"325","author":"MA Mederos","year":"2021","journal-title":"JAMA"},{"issue":"4","key":"pone.0323321.ref006","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/MPA.0000000000000783","article-title":"The Changing Epidemiology of Acute Pancreatitis Hospitalizations: A Decade of Trends and the Impact of Chronic Pancreatitis","volume":"46","author":"SG Krishna","year":"2017","journal-title":"Pancreas"},{"issue":"1","key":"pone.0323321.ref007","doi-asserted-by":"crossref","first-page":"10013","DOI":"10.1038\/s41598-023-37127-8","article-title":"Prognostic impact of blood urea nitrogen to albumin ratio on patients with sepsis: a retrospective cohort study","volume":"13","author":"Y Wang","year":"2023","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0323321.ref008","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.606","article-title":"The role of blood urea nitrogen to serum albumin ratio in the prediction of severity and 30-day mortality in patients with COVID-19","volume":"5","author":"T Alirezaei","year":"2022","journal-title":"Health Sci Rep"},{"issue":"1","key":"pone.0323321.ref009","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s12890-022-02258-7","article-title":"Blood urea nitrogen to serum albumin ratio: a good predictor of in-hospital and 90-day all-cause mortality in patients with acute exacerbations of chronic obstructive pulmonary disease","volume":"22","author":"Z Zeng","year":"2022","journal-title":"BMC Pulm Med"},{"key":"pone.0323321.ref010","doi-asserted-by":"crossref","first-page":"888736","DOI":"10.3389\/fcvm.2022.888736","article-title":"Elevated Blood Urea Nitrogen to Serum Albumin Ratio Is an Adverse Prognostic Predictor for Patients Undergoing Cardiac Surgery","volume":"9","author":"L Ye","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"1","key":"pone.0323321.ref011","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1186\/s12871-023-02384-7","article-title":"Relationship between blood urea nitrogen to serum albumin ratio and short-term mortality among patients from the surgical intensive care unit: a population-based real-world study","volume":"23","author":"J Zhang","year":"2023","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"pone.0323321.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset","volume":"10","author":"AEW Johnson","year":"2023","journal-title":"Sci Data"},{"key":"pone.0323321.ref013","first-page":"1573931","article-title":"Development of a novel nomogram incorporating red blood cell distribution width-albumin ratio for the prediction of 30-day mortality in acute pancreatitis patients","volume":"2022","author":"L Pan","year":"2022","journal-title":"Emerg Med Int"},{"key":"pone.0323321.ref014","doi-asserted-by":"crossref","first-page":"1076121","DOI":"10.3389\/fimmu.2022.1076121","article-title":"Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database","volume":"13","author":"Q Liu","year":"2022","journal-title":"Front Immunol"},{"key":"pone.0323321.ref015","doi-asserted-by":"crossref","first-page":"1373371","DOI":"10.3389\/fimmu.2024.1373371","article-title":"Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database","volume":"15","author":"J Wang","year":"2024","journal-title":"Front Immunol"},{"key":"pone.0323321.ref016","doi-asserted-by":"crossref","first-page":"5449","DOI":"10.2147\/IJGM.S327123","article-title":"Prognostic Value of Glucose-to-Lymphocyte Ratio in Critically Ill Patients with Acute Pancreatitis","volume":"14","author":"Y Chen","year":"2021","journal-title":"Int J Gen Med"},{"issue":"4","key":"pone.0323321.ref017","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/bja\/85.4.599","article-title":"The role of albumin in critical illness","volume":"85","author":"JP Nicholson","year":"2000","journal-title":"Br J Anaesth"},{"issue":"2","key":"pone.0323321.ref018","first-page":"231","article-title":"Albumin inhibits human polymorphonuclear leucocyte luminol-dependent chemiluminescence: evidence for oxygen radical scavenging","volume":"65","author":"ME Holt","year":"1984","journal-title":"Br J Exp Pathol"},{"issue":"18","key":"pone.0323321.ref019","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.clinbiochem.2010.08.025","article-title":"Serum albumin and biomolecular oxidative damage of human atherosclerotic plaques","volume":"43","author":"D Lapenna","year":"2010","journal-title":"Clin Biochem"},{"key":"pone.0323321.ref020","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000413163","article-title":"Effect of plasma and interstitial protein content on tissue edema formation","volume":"53","author":"RH Demling","year":"1986","journal-title":"Curr Stud Hematol Blood Transfus"},{"issue":"3","key":"pone.0323321.ref021","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.SLA.0000055547.93484.87","article-title":"Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials","volume":"237","author":"J-L Vincent","year":"2003","journal-title":"Ann Surg"},{"issue":"5","key":"pone.0323321.ref022","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.amjcard.2010.04.024","article-title":"Emergence of blood urea nitrogen as a biomarker of neurohormonal activation in heart failure","volume":"106","author":"A Kazory","year":"2010","journal-title":"Am J Cardiol"},{"issue":"11","key":"pone.0323321.ref023","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.amjcard.2008.01.047","article-title":"Relation of blood urea nitrogen to long-term mortality in patients with heart failure","volume":"101","author":"CA Cauthen","year":"2008","journal-title":"Am J Cardiol"},{"issue":"1","key":"pone.0323321.ref024","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s12871-023-02212-y","article-title":"Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study","volume":"23","author":"KN Nguyen","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"pone.0323321.ref025","doi-asserted-by":"crossref","first-page":"926320","DOI":"10.3389\/fneur.2022.926320","article-title":"Association Between Pre-operative BUN and Post-operative 30-Day Mortality in Patients Undergoing Craniotomy for Tumors: Data From the ACS NSQIP Database","volume":"13","author":"Y Liu","year":"2022","journal-title":"Front Neurol"},{"issue":"1","key":"pone.0323321.ref026","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jcrc.2009.02.002","article-title":"Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis","volume":"25","author":"M Faisst","year":"2010","journal-title":"J Crit Care"},{"issue":"4","key":"pone.0323321.ref027","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/j.athoracsur.2014.11.034","article-title":"Postoperative blood urea nitrogen is associated with stroke in cardiac surgical patients","volume":"99","author":"M Arnan","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"11","key":"pone.0323321.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143486","article-title":"Prediction of Severe Acute Pancreatitis Using a Decision Tree Model Based on the Revised Atlanta Classification of Acute Pancreatitis","volume":"10","author":"Z Yang","year":"2015","journal-title":"PLoS One"},{"issue":"10","key":"pone.0323321.ref029","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.ajem.2020.06.067","article-title":"Lactate\/albumin ratio: An early prognostic marker in critically ill patients","volume":"38","author":"A Gharipour","year":"2020","journal-title":"Am J Emerg Med"},{"issue":"5","key":"pone.0323321.ref030","doi-asserted-by":"crossref","first-page":"909","DOI":"10.2215\/CJN.00320106","article-title":"Age-related increase in plasma urea level and decrease in fractional urea excretion: clinical application in the syndrome of inappropriate secretion of antidiuretic hormone","volume":"1","author":"W Musch","year":"2006","journal-title":"Clin J Am Soc Nephrol"},{"issue":"13","key":"pone.0323321.ref031","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1001\/jama.1994.03520130074036","article-title":"Serum albumin level and physical disability as predictors of mortality in older persons","volume":"272","author":"MC Corti","year":"1994","journal-title":"JAMA"},{"key":"pone.0323321.ref032","article-title":"Machine Learning for Predicting Risk and Prognosis of Acute Kidney Disease in Critically Ill Elderly Patients During Hospitalization: Internet-Based and Interpretable Model Study","volume":"26","author":"M Li","year":"2024","journal-title":"J Med Internet Res"},{"issue":"11","key":"pone.0323321.ref033","doi-asserted-by":"crossref","first-page":"11653","DOI":"10.21037\/apm-21-2937","article-title":"Association between blood urea nitrogen and 30-day mortality in patients with sepsis: a retrospective analysis","volume":"10","author":"X Li","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"6","key":"pone.0323321.ref034","first-page":"2409","article-title":"Analysis of risk factors affecting the prognosis of patients with sepsis and construction of nomogram prediction model","volume":"28","author":"SH Cui","year":"2024","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"1","key":"pone.0323321.ref035","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1186\/s12872-024-04184-4","article-title":"Comparison of different intensive care scoring systems and Glasgow Aneurysm score for aortic aneurysm in predicting 28-day mortality: a retrospective cohort study from MIMIC-IV database","volume":"24","author":"H Wang","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"pone.0323321.ref036","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ijid.2021.11.015","article-title":"SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria","volume":"114","author":"Y Zhu","year":"2022","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pone.0323321.ref037","doi-asserted-by":"crossref","first-page":"3170","DOI":"10.1038\/s41598-024-53384-7","article-title":"Association between alkaline phosphatase to albumin ratio and mortality among patients with sepsis","volume":"14","author":"S Liu","year":"2024","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T17:50:40Z","timestamp":1747331440000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323321"}},"subtitle":[],"editor":[{"given":"Keiko","family":"Hosohata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323321","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}