{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:00:02Z","timestamp":1790312402881,"version":"4.1.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis-associated delirium (SAD) is a frequent manifestation of acute brain dysfunction in sepsis. Although the blood urea nitrogen-to-albumin ratio (BAR) has been associated with prognosis in critically ill patients, its relationship with incident SAD remains uncertain. We evaluated the association between early BAR and incident SAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study included patients with sepsis from MIMIC-IV as the primary cohort and eICU-CRD as an independent replication cohort. BAR was calculated from eligible blood urea nitrogen and serum albumin measurements obtained within 24 h after the index time. The primary outcome was 7-day incident delirium; 3-day delirium was additionally evaluated in MIMIC-IV. Death before delirium was treated as a competing event. Covariates were selected using Boruta and LASSO regression. CBPS-based inverse probability weighting and Fine\u2013Gray competing-risk regression were applied, with restricted cubic spline, subgroup, and exploratory XGBoost\/SHAP analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 10,565 patients were included (9,612 MIMIC-IV; 953 eICU-CRD). In MIMIC-IV, the highest BAR quartile was associated with a greater subdistribution hazard of 7-day delirium vs. the lowest quartile (fully adjusted sHR 1.36, 95% CI 1.13\u20131.64;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001;\n                      <jats:italic>P<\/jats:italic>\n                      for trend = 0.002). Continuous BAR was also associated with 7-day delirium (sHR per 1-unit increase 1.00, 95% CI 1.00\u20131.01;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.013), with similar findings for 3-day delirium. In eICU-CRD, the highest BAR quartile was likewise associated with 7-day delirium (sHR 2.20, 95% CI 1.13\u20134.29;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.020;\n                      <jats:italic>P<\/jats:italic>\n                      for trend = 0.012), whereas the continuous association was not statistically significant (sHR 1.01, 95% CI 1.00\u20131.02;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.075). Restricted cubic spline analyses suggested potential nonlinearity, particularly in MIMIC-IV. Exploratory SHAP analyses ranked BAR among the most influential model-based predictors in both cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher early BAR, particularly values in the highest quartile, was associated with a greater subdistribution hazard of incident SAD, and the highest-quartile association was independently reproduced in eICU-CRD. BAR may serve as a simple risk-associated marker for identifying patients with sepsis at higher risk of incident delirium.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1919287","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:14Z","timestamp":1790310434000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated blood urea nitrogen-to-albumin ratio is associated with incident sepsis-associated delirium: evidence from a weighted competing-risk analysis in a multicenter cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yun","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Zhongnan Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The University of Hong Kong-Shenzhen Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang-Tao","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The University of Hong Kong-Shenzhen Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s13054-023-04385-x","article-title":"National incidence and mortality of hospitalized sepsis in China","volume":"27","author":"Weng","year":"2023","journal-title":"Crit Care."},{"key":"B2","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s13054-024-04932-0","article-title":"Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000\u20132022: a binational cohort 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