Can the blood urea nitrogen to serum albumin ratio be used as a mortality predictor in patients with pneumonia after cardiac surgery?

Yıl 2022, Cilt: 8 Sayı: 2, 155 - 161, 04.03.2022

Ahmet Kağan As , Arda Aybars Pala , Orhan Güvenç , Senol Yavuz

https://doi.org/10.18621/eurj.1030236

Öz

Objectives: Serious complications are seen after cardiac surgery operations. Postoperative pneumonia is one of the most important of these complications. Some biomarkers have been examined in the prediction of mortality in special groups such as hospital-acquired pneumonia or aspiration pneumonia. In addition to parameters such as blood-urea nitrogen and albumin, the blood urea nitrogen to albumin ratio obtained by the ratio of these two parameters is also used as a mortality predictor. In this study, it was aimed to investigate the effect of the blood urea nitrogen to albumin ratio at the time of diagnosis of pneumonia on mortality in patients who developed pneumonia in the early period after cardiac surgery.

Methods: In this study, 138 patients who developed pneumonia in the early period after cardiac surgery were examined. Complete blood count and biochemical test results were analyzed for all patients, and differences between groups were investigated. The patients who developed in-hospital pneumonia and were discharged as survivors were classified as Group 1, and non-survivor patients were determined as Group 2.

Results: Patients who did not develop in-hospital mortality were included in Group 1 (n = 105, mean age = 63.7 ± 9.2 years), and those with non-survivor were included in Group 2 (n = 33, mean age = 66.9 ± 9.6 years). At the time of diagnosis neutrophil-lymphocyte ratio, C-reactive protein, blood-urea nitrogen and blood urea nitrogen to albumin ratio values were significantly higher in Group 2 (p < 0.001, p < 0.001, p = 0.004 and p < 0.001; respectively) ROC curve analysis was performed to evaluate blood urea nitrogen to albumin ratio in predicting mortality. The cut-off value of blood urea nitrogen to albumin ratio was 4.1 (Area under the curve [AUC]: 0.740, 95% CI: 0.690-0.820, p < 0.001, with sensitivity of 72.5% and specificity of 68.6%).

Conclusions: In pneumonia developing after cardiac surgery, we found that the peripheral blood blood urea nitrogen to albumin ratio at the time of the first symptom in the patient has a high predictive power for the development of mortality in this particular patient group.

Anahtar Kelimeler

Cardiac surgery, postoperative pneumonia, mortality, prediction

Kaynakça

• 1. Gucu A, Ozluk OA, Sunbul SA, Engin M, Seker IB, Sunbul A. Prognostic nutritional index as a marker of mortality: an observational cohort study of patients undergoing cardiac surgery. Rev Cardiovasc Med 2021;22:499-503.
• 2. Hortal J, Muñoz P, Cuerpo G, Litvan H, Rosseel PM, Bouza E; European Study Group on Nosocomial Infections; European Workgroup of Cardiothoracic Intensivists. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe. Crit Care 2009;13:R80.
• 3. Ibañez J, Riera M, Amezaga R, Herrero J, Colomar A, Campillo-Artero C, et al. Long-term mortality after pneumonia in cardiac surgery patients: a propensity-matched analysis. J Intensive Care Med 2016;31:34-40.
• 4. Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997;112:666-75.
• 5. Tamayo E, Álvarez FJ, Martínez-Rafael B, Bustamante J, Bermejo-Martin JF, Fierro I, et al. Valladolid Sepsis Study Group. Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery. J Crit Care 2012;27:18-25.
• 6. Engin M, Ozsin KK, Savran M, Guvenc O, Yavuz S, Ozyazicioglu AF. Visceral adiposity index and prognostic nutritional index in predicting atrial fibrillation after on-pump coronary artery bypass operations: a prospective study. Braz J Cardiovasc Surg 2021;36:522-9.
• 7. Perry LA, Liu Z, Loth J, Penny-Dimri JC, Plummer M, Segal R, et al. Perioperative neutrophil-lymphocyte ratio predicts mortality after cardiac surgery: systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2021. doi: 10.1053/j.jvca.2021.07.001.
• 8. Erdolu B, Engin M. Can C-reactive protein to albumin ratio be used as a predictor of amputation development in acute lower extremity ischemia? J Surg Med 2020;4:501-4.
• 9. Ito A, Ishida T, Tokumasu H, Washio Y, Yamazaki A, Ito Y, et al. Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort. BMC Pulm Med 2021;17:78.
• 10. Feng DY, Zhou YQ, Zou XL, Zhou M, Yang HL, Chen XX, et al. Elevated blood urea nitrogen-to-serum albumin ratio as a factor that negatively affects the mortality of patients with hospital-acquired pneumonia. Can J Infect Dis Med Microbiol 2019;2019:1547405.
• 11. Ryu S, Oh SK, Cho SU, You Y, Park JS, Min JH, et al. Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients. Am J Emerg Med 2021;43:175-9.
• 12. Köse A, Yurtseven N, Yakın Düzyol İ. Ventilator associated pneumonia after open heart surgery: risk factors. J CardiovascThorac Anaesth Intensive Care Soc 2019;25:181-9.
• 13. Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992;152:125-30.
• 14. Yayla C, Gayretli Yayla K. C-reactive protein to albumin ratio in patients with saphenous vein graft disease. Angiology 2021;72:770-5.
• 15. Karabacak K, Kubat E, Akyol FB, Kadan M, Erol G, Doğancı S, et al. The C-reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery. J Card Surg 2020;35:2747-53.
• 16. Akgul E, Parlar AI, Erkul GSA, Erkul S, Cekirdekci A. Investigation of the effect of preoperative hypoalbuminemia, blood urea nitrogen and creatinine levels on postoperative atrial fibrillation on off-pump coronary bypass surgery patients. Heart Surg Forum 2020;23:E641-6.
• 17. Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 2004;116:466-73.
• 18. Bae SJ, Lee SH, Yun SJ, Kim K. Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke. Signa Vitae 2021;17:163-70.
• 19. Dundar ZD, Kucukceran K, Ayranci MK. Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients. Am J Emerg Med 2021;46:349-54.
• 20. Fang J, Xu B. Blood urea nitrogen to serum albumin ratio independently predicts mortality in critically ill patients with acute pulmonary embolism. Clin Appl Thromb Hemost 2021;27:10760296211010241.
• 21. Ata F, As AK, Engin M, Kacmaz Kat N, Ata Y, Turk T. Can blood urea nitrogen-to-albumin ratio predict mortality in patients with moderate-to-severe COVID-19 pneumonia hospitalized in the intensive care unit? Rev Assoc Med Bras (1992) 2021;67:1421-6.
• 22. Bouza E, Pérez A, Muñoz P, Jesús Pérez M, Rincón C, Sánchez C, et al. Cardiovascular Infection Study Group. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med 2003;31:1964-70.
• 23. Sheng W, Chi YF, Hou WM, Sun L, Niu ZZ, Sun Y et al. [Clinical analysis of 105 cases of ventilator-associated pneumonia after heart surgery]. Zhonghua Xin Xue Guan Bing Za Zhi 2012;40:825-9. [Article in Chinese].
• 24. Ailawadi G, Chang HL, O'Gara PT, O'Sullivan K, Woo YJ, DeRose JJ Jr, et al. Pneumonia after cardiac surgery: experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg 2017;153:1384-91.e3.
• 25. Cappabianca G, Paparella D, Visicchio G, Capone G, Lionetti G, Numis F, et al. Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery. Ann Thorac Surg 2006;82:2170-8.
• 26. Perrotti A, Chenevier-Gobeaux C, Ecarnot F, Bardonnet K, Barrucand B, Flicoteaux G, et al. Is endocan a diagnostic marker for pneumonia after cardiac surgery? The ENDOLUNG Study. Ann Thorac Surg 2018;105:535-41.
• 27. Boralessa H, de Beer FC, Manchie A, Whitwam JG, Pepys MB. C-reactive protein in patients undergoing cardiac surgery. Anaesthesia 1986;41:11-5.