Blood urea nitrogen-to-albumin ratio predicts mortality in acute graft-versus- host disease after allogeneic stem cell transplantation.
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BACKGROUND: 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. OBJECTIVE: This study aimed to evaluate the prognostic significance of BAR levels in patients developing aGVHD following allo-HSCT. METHODS: 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. RESULTS: Among 109 included patients (mean age 29.4 ± 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 1.66-9.16; p=0.006) and non-relapse mortality (NRM) (HR=5.26, 95% CI 1.48-8.71; p=0.010). Tertile analysis (T3 vs. T1) showed higher ACM (HR=2.19, 95% CI 1.05-4.57; p=0.037) and NRM (HR=2.07, 95% CI 1.01-4.22; p=0.046), with significant dose-response trends (p<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 p>0.05). Sensitivity analyses confirmed robustness of these associations. CONCLUSION: Elevated BAR levels independently predict increased mortality in allo-HSCT recipients with aGVHD, suggesting its utility as a pragmatic prognostic biomarker requiring prospective validation.