{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:45:39Z","timestamp":1791805539592,"version":"4.3.4"},"reference-count":14,"publisher":"FapUNIFESP (SciELO)","issue":"10","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: Sepsis is a life-threatening condition characterized by dysregulated host responses to infection and high mortality in intensive care units. Existing prognostic models are often complex or resource-intensive. The blood urea nitrogen-to-albumin ratio, reflecting renal function, metabolic stress, and nutritional status, has emerged as a potential prognostic biomarker. The aim of this study was to evaluate the predictive value of blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients.  METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Adult patients meeting Sepsis-3 criteria were included. Suspected infection was defined by antibiotic administration and microbiological culture within 24 h. Demographic, clinical, and laboratory data were collected, and blood urea nitrogen-to-albumin ratio was calculated using values obtained within the first 24 h of intensive care unit admission. Receiver operating characteristic curve analysis, Kaplan-Meier survival analysis, and multivariate Cox regression were performed.  RESULTS: A total of 6,940 patients were included, with a 28-day mortality rate of 21.6%. Blood urea nitrogen-to-albumin ratio demonstrated superior predictive performance (area under the curve (AUC)=0.647, 95%CI 0.631\u20130.664) compared with serum urea (AUC=0.634) and albumin (AUC=0.428), and also outperformed the Sequential Organ Failure Assessment score (AUC=0.613). The optimal cutoff value was 7.6. Patients with blood urea nitrogen-to-albumin ratio \u22657.6 had significantly higher mortality than those with lower values (p&lt;0.001). Elevated blood urea nitrogen-to-albumin ratio remained an independent predictor of mortality after adjustment.  CONCLUSION: Blood urea nitrogen-to-albumin ratio is a simple, objective, and readily available biomarker associated with 28-day mortality in septic intensive care unit patients and may contribute to risk stratification when used alongside other clinical parameters.<\/jats:p>","DOI":"10.1590\/1806-9282.20260593","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:57:22Z","timestamp":1791802642000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of the blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients: a large-scale retrospective cohort study using the Medical Information Mart for Intensive Care IV database"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7565-264X","authenticated-orcid":false,"given":"Jiatong","family":"Hou","sequence":"first","affiliation":[{"name":"Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2190-9355","authenticated-orcid":false,"given":"Jiaqi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-2453","authenticated-orcid":false,"given":"Wentao","family":"Liu","sequence":"additional","affiliation":[{"name":"Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8935-1198","authenticated-orcid":false,"given":"Yuefu","family":"Wang","sequence":"additional","affiliation":[{"name":"Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1038\/s41569-020-00492-2","article-title":"Pathophysiology of sepsis-induced cardiomyopathy","volume":"18","author":"Hollenberg SM","year":"2021","journal-title":"Nat Rev Cardiol"},{"issue":"1123","key":"ref2","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/postgradmedj-2018-136371","article-title":"TnI and IL-18 levels are associated with prognosis of sepsis","volume":"95","author":"Wu Q","year":"2019","journal-title":"Postgrad Med J"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/ncp.10232","article-title":"Pathophysiology of critical illness and role of nutrition","volume":"34","author":"Sharma K","year":"2019","journal-title":"nutrition in clinical practice: official publication of the American Society for 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prognosis of patients with sepsis during hospitalization","volume":"22","author":"Min J","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"7","key":"ref10","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000033007","article-title":"Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: a meta-analysis","volume":"102","author":"Hung K","year":"2023","journal-title":"Medicine"},{"key":"ref11","doi-asserted-by":"crossref","DOI":"10.1177\/10760296211010241","article-title":"Blood urea nitrogen to serum albumin ratio independently predicts mortality in critically Ill patients with acute pulmonary embolism","volume":"27","author":"Fang J","year":"2021","journal-title":"Clin Appl Thromb Hemost"},{"issue":"1","key":"ref12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13054-021-03500-0","article-title":"Role of endothelial microRNA 155 on capillary leakage in systemic 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