Predictive value of blood urea nitrogen/serum albumin ratio for death in patients with coronary heart disease complicated with chronic heart failure

Xiong Wenxiao; Xue Jiaoping; Wang Yujing; Yang Xiaomin; Wang Lei; Zhang Yanbo; Tian Jing

doi:10.3969/j.issn.1674-4055.2025.08.06

Abstract：Objective To investigate the predictive value of blood urea nitrogen/serum albumin ratio(BAR)for death in patients with coronary heart disease(CHD)combined with chronic heart failure(CHF).Methods A prospective cohort study was conducted.A total of 5106 patients with CHD complicated with CHF were enrolled from the Department of Cardiology,First Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital,from January 2014 to March 2019.Hospitalization data were collected,and death information was followed up at 1,3,and 6 months after discharge,and then every 6 months thereafter.The median follow-up time was 30.87(14.73,49.20)months.Cox proportional risk regression model and Kaplan-Meier survival curve were used to analyze the effect of BAR on the long-term prognosis of patients with CHD combined with CHF.Receiver operating characteristic(ROC)curve analysis was used to calculate the Youden index and determine the optimal cutoff value of BAR.Based on this threshold,patients were divided into low-value and high-value groups to evaluate the predictive performance of BAR for death in these patients.Results No patients were to follow-up,with a total of 465(9.11%)patients dying,including 204(5.94%)in the low BAR group and 261(15.64%)in the high BAR group.Multifactorial Cox regression analysis showed that advanced age(HR=1.035,P＜0.001),high level of N-terminal pro-B-type natriuretic peptide(NT-proBNP),(HR=2.130,P＜0.001),comorbid chronic obstructive pulmonary disease(COPD),(HR=1.508,P＜0.001),and high level of BAR(HR=1.632,P＜0.001)were the independent risk factors for death in patients with CHD combined with CHF.High levels of diastolic blood pressure(HR=0.987,P=0.001),Heart Failure with preserved Ejection Fraction(HFpEF),(HR=0.680,P=0.001),administration of β-blockers(HR=0.756,P=0.005),and revascularization(HR=0.729,P=0.009)were the independent protective factors for death in these patients.Kaplan-Meier survival analysis showed that the higher the BAR,the lower the cumulative survival rate of patients with CHD combined with CHF,and the difference between groups was statistically significant(P＜0.001).ROC curve analysis showed that,BAR could predict death in patients with CHD combined with CHF,and the area under an ROC curve was 0.655,the optimal cutoff was 0.17,with sensitivity of 56.1%and specificity of 69.7%,(P＜0.001).Conclusion The risk of death in patients with CHD complicated with CHF increases with elevated BAR,and BAR has a predictive value for death in these patients.