A higher preoperative blood urea nitrogen–to–albumin ratio was associated with increased 30-day mortality in patients with hip fracture undergoing surgery.
In a retrospective cohort study, researchers evaluated 514 patients aged 65 years and older who underwent surgery for intertrochanteric femur fractures at a single center. The blood urea nitrogen-to-albumin ratio (BAR) measured metabolic stress, renal perfusion, and nutritional status; was calculated using routine laboratory values obtained within 2 hours of presentation; and was compared with other biomarkers, including the C-reactive protein–to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and fibrinogen-to-albumin ratio. The primary outcome was all-cause mortality within 30 days postsurgery.
Overall, 10.5% (n = 54) of the patients died within 30 days. The researchers found that those who died had higher BAR values and lower albumin levels compared with survivors. A BAR value of 9 or greater was associated with about 2.7 times the odds of 30-day mortality after adjustment for age, sex, comorbidities, and American Society of Anesthesiologists classification. BAR showed the strongest predictive performance among the evaluated biomarkers, with 79% sensitivity and 72% specificity at the identified cutoff.
Although other biomarkers, including the C-reactive protein–to-albumin ratio and neutrophil-to-lymphocyte ratio, were also elevated in patients who died, these measures didn't remain independently associated with mortality in adjusted analyses. The researchers noted that BAR values reflect multiple physiologic factors that may contribute to its association with early mortality.
The study was limited by its retrospective, single-center design and the potential for unmeasured confounding factors such as hydration status, nutritional condition, and frailty. The analysis focused on short-term outcomes and didn't include cause-specific mortality or long-term follow-up.
“Preoperative BAR is an independent biomarker for predicting early mortality in elderly patients with intertrochanteric hip fractures. Its simplicity and routine clinical availability support its potential use in preoperative risk stratification,” wrote lead study author Bahri Bozgeyik, of the Department of Orthopaedics and Traumatology in the Gaziantep University Medicine Faculty at the Şahinbey Research and Practice Hospital in Turkey, and colleagues.
The study authors reported no funding or competing interests.
