{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:04:09Z","timestamp":1784178249125,"version":"3.55.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence regarding the association between the blood urea nitrogen to albumin ratio (BAR) and clinical outcomes in acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the prognostic significance of BAR levels in patients developing aGVHD following allo-HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort analysis of allo-HSCT recipients at Henan Cancer Hospital (January 2019-December 2024). Eligible participants were diagnosed with aGVHD during post-transplantation follow-up. Demographic characteristics, BAR measurements, and clinical outcomes were extracted from electronic medical records. Primary endpoints comprised all-cause mortality (ACM) and non-relapse mortality (NRM). Multivariable Cox proportional hazards models with confounder adjustment and subgroup analyses were employed to assess mortality associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 109 included patients (mean age 29.4 \u00b1 15.3 years), 51 presented with grade I-II aGVHD and 58 with grade III-IV aGVHD. During the 30-month follow-up, 69 deaths, 3 relapse\/progression events, and 37 survivors were documented. Elevated BAR (continuous) independently predicted increased all-cause mortality (ACM) (HR=5.92, 95% CI 1.66\u20139.16; p=0.006) and non-relapse mortality (NRM) (HR=5.26, 95% CI 1.48\u20138.71; p=0.010). Tertile analysis (T3 vs. T1) showed higher ACM (HR=2.19, 95% CI 1.05\u20134.57; p=0.037) and NRM (HR=2.07, 95% CI 1.01\u20134.22; p=0.046), with significant dose-response trends (p&amp;lt;0.05). Kaplan-Meier analysis confirmed inferior survival in high-BAR groups (OS p=0.0091; RFS p=0.015). Subgroup analyses demonstrated consistent effects across age, sex, conditioning regimens, graft types, and ABO compatibility (interaction\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt;0.05). Sensitivity analyses confirmed robustness of these associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated BAR levels independently predict increased mortality in allo-HSCT recipients with aGVHD, suggesting its utility as a pragmatic prognostic biomarker requiring prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1796065","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:20:45Z","timestamp":1784175645000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Blood urea nitrogen-to-albumin ratio predicts mortality in acute graft-versus- host disease after allogeneic stem cell transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Gangping","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Records Management, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The 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