JPEN. Journal of parenteral and enteral nutrition · 2026
Urea-to-Creatinine-Ratio and the risk of 28-day mortality in critically ill adults with or without Acute Kidney Injury: A post-hoc analysis of a randomized clinical trial.
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Zhou Lingliang, Lv Cheng, Zhang Xiangcheng, Liu Yang, Zhou Yufeng, Zanten Arthur Raymond Hubert van, Mao Wenjian, Ke Lu, Li Weiqin, Chinese Critical Care Nutrition Trials Group (CCCNTG)
Аннотация
BACKGROUND: The prognostic value of the urea-to-creatinine ratio in critically ill adults may vary according to the timing of measurement and baseline acute kidney injury status. We hypothesized that higher urea-to-creatinine ratios measured on study Days 1 and 7 would be associated with higher 28-day mortality, and that these associations would differ according to baseline acute kidney injury status.
METHODS: We performed a post hoc analysis of the multicenter cluster-randomized trial. The urea-to-creatinine ratio was measured on study Days 1 and 7 (mmol/mmol). Restricted cubic spline-adjusted Cox models assessed associations between the urea-to-creatinine ratio and time to death through Day 28 in the overall population and according to baseline acute kidney injury status. Multivariable linear regression identified factors associated with Day 7 urea-to-creatinine ratio.
RESULTS: The Day 1 and Day 7 analyses included 2613 and 2516 patients, respectively. The urea-to-creatinine ratio was higher on Day 7 than on Day 1 and lower in patients with baseline acute kidney injury than in those without baseline acute kidney injury. No clear association was observed between the Day 1 urea-to-creatinine ratio and 28-day mortality in the overall population or after stratification by baseline acute kidney injury status. The Day 7 urea-to-creatinine ratio was associated with 28-day mortality in the overall population and showed a U-shaped association in patients without baseline acute kidney injury, whereas no clear association was observed in patients with baseline acute kidney injury. In the Day 7 cohort without baseline acute kidney injury, low and high urea-to-creatinine ratio cohorts had higher mortality than the middle urea-to-creatinine ratio cohort, with adjusted hazard ratios of 2.06 (95% confidence interval, 1.30-3.26) and 2.21 (95% confidence interval, 1.45-3.38), respectively. Higher protein delivery and older age were associated with higher Day 7 urea-to-creatinine ratio, whereas baseline acute kidney injury, male sex, and higher body mass index were associated with lower Day 7 urea-to-creatinine ratio.
CONCLUSION: No clear association between the Day 1 urea-to-creatinine ratio and 28-day mortality was observed in the overall population or after stratification by baseline acute kidney injury status. On Day 7, the urea-to-creatinine ratio was associated with 28-day mortality, with a U-shaped association in patients without baseline acute kidney injury but no clear association in patients with baseline acute kidney injury. The urea-to-creatinine ratio should be interpreted cautiously in patients with acute kidney injury.
METHODS: We performed a post hoc analysis of the multicenter cluster-randomized trial. The urea-to-creatinine ratio was measured on study Days 1 and 7 (mmol/mmol). Restricted cubic spline-adjusted Cox models assessed associations between the urea-to-creatinine ratio and time to death through Day 28 in the overall population and according to baseline acute kidney injury status. Multivariable linear regression identified factors associated with Day 7 urea-to-creatinine ratio.
RESULTS: The Day 1 and Day 7 analyses included 2613 and 2516 patients, respectively. The urea-to-creatinine ratio was higher on Day 7 than on Day 1 and lower in patients with baseline acute kidney injury than in those without baseline acute kidney injury. No clear association was observed between the Day 1 urea-to-creatinine ratio and 28-day mortality in the overall population or after stratification by baseline acute kidney injury status. The Day 7 urea-to-creatinine ratio was associated with 28-day mortality in the overall population and showed a U-shaped association in patients without baseline acute kidney injury, whereas no clear association was observed in patients with baseline acute kidney injury. In the Day 7 cohort without baseline acute kidney injury, low and high urea-to-creatinine ratio cohorts had higher mortality than the middle urea-to-creatinine ratio cohort, with adjusted hazard ratios of 2.06 (95% confidence interval, 1.30-3.26) and 2.21 (95% confidence interval, 1.45-3.38), respectively. Higher protein delivery and older age were associated with higher Day 7 urea-to-creatinine ratio, whereas baseline acute kidney injury, male sex, and higher body mass index were associated with lower Day 7 urea-to-creatinine ratio.
CONCLUSION: No clear association between the Day 1 urea-to-creatinine ratio and 28-day mortality was observed in the overall population or after stratification by baseline acute kidney injury status. On Day 7, the urea-to-creatinine ratio was associated with 28-day mortality, with a U-shaped association in patients without baseline acute kidney injury but no clear association in patients with baseline acute kidney injury. The urea-to-creatinine ratio should be interpreted cautiously in patients with acute kidney injury.