ROLE OF UREA TO ALBUMIN RATIO AS A PREDICTOR OF IN - HOSPITAL MORTALITY IN SEVERE PNEUMONIA PATIENTS

Abstract

Background: Urea to albumin ratio (UAR), as a marker of renal dysfunction along with systemic inflammation and nutrition has been suggested as a potential prognostic marker in critically ill patients. Objective: To determine the role of urea-to-albumin ratio as a predictor of in-hospital mortality among patients with severe pneumonia admitted to intensive care units. Methods: Prospective cohort study was carried out at the intensive care units of Jinnah Postgraduate Medical Centre, Karachi over a period of six months. Consecutive sampling method was used to recruit a total of 80 adult patients with severe pneumonia, who were divided into high UAR (>0.2555) and low UAR (<0.2555) groups according to the UAR value. Demographic data, clinical data and CURB-65, APACHE II and SOFA scores were collected. Relative risk analysis, receiver operating characteristic (ROC) curve analysis, and multivariable Cox regression were used to evaluate the association of UAR with in-hospital mortality. Results: In 24 patients (30.0%) death occurred within the hospital. The high UAR group had significantly higher mortality rate than the low UAR group (45.0% vs. 15.0%, respectively, p=0.004). A higher UAR was linked to higher mortality risk (RR=3.00, 95% CI: 1.38–6.51). The ROC analysis showed that the UAR had good predictive ability for in-hospital death (AUC=0.78; 95% CI: 0.67–0.89) when the cut-off value was 0.2555, with a sensitivity of 75.0% and a specificity of 70.0%. Conclusion: Increased urea/albumin ratio is a predictor of the in-hospital mortality of severe pneumonia independent of other factors.