Frontiers in nutrition · 2026
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.
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Xia Yun, Jin Jun, Deng Jiang-Tao
Аннотация
BACKGROUND: 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.
METHODS: 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-Gray competing-risk regression were applied, with restricted cubic spline, subgroup, and exploratory XGBoost/SHAP analyses.
RESULTS: 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 1.13-1.64; P = 0.001; P for trend = 0.002). Continuous BAR was also associated with 7-day delirium (sHR per 1-unit increase 1.00, 95% CI 1.00-1.01; P = 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 1.13-4.29; P = 0.020; P for trend = 0.012), whereas the continuous association was not statistically significant (sHR 1.01, 95% CI 1.00-1.02; P = 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.
CONCLUSION: 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.
METHODS: 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-Gray competing-risk regression were applied, with restricted cubic spline, subgroup, and exploratory XGBoost/SHAP analyses.
RESULTS: 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 1.13-1.64; P = 0.001; P for trend = 0.002). Continuous BAR was also associated with 7-day delirium (sHR per 1-unit increase 1.00, 95% CI 1.00-1.01; P = 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 1.13-4.29; P = 0.020; P for trend = 0.012), whereas the continuous association was not statistically significant (sHR 1.01, 95% CI 1.00-1.02; P = 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.
CONCLUSION: 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.