ArticleJournal of thoracic disease2026
Association between blood urea nitrogen-to-creatinine ratio trajectories and mortality in patients with severe pneumonia requiring invasive mechanical ventilation: a Medical Information Mart for Intensive Care IV (MIMIC-IV) database analysis.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Once pneumonia patients progress to requiring invasive mechanical ventilation (IMV), mortality in the intensive care unit (ICU) increases substantially. The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients, yet its dynamic prognostic value in ICU-admitted pneumonia patients remains unclear. This study employed group-based trajectory modeling (GBTM) to explore the association between early dynamic changes in BUNCR and mortality. Methods: This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV version 3.1 (MIMIC-IV v3.1). We included 3,609 adults (≥18 years) with pneumonia who initiated IMV within 24 hours of their first ICU admission and had ≥3 BUNCR measurements within 5 days. GBTM identified distinct BUNCR trajectories. Adjusted mortality hazard ratios (HRs) were calculated using Cox proportional hazards regression and multivariate logistic regression models. Finally, Kaplan-Meier survival analysis and subgroup analyses were performed. Results: The study identified three distinct BUNCR trajectories: Group 1 (medium, gradually increasing), Group 2 (lowest, slight initial decrease), and Group 3 (highest, rapid early increase). Overall, 14-day and 28-day mortality rates were 15.99% and 23.14%, respectively. Group 3 exhibited the highest mortality (25.95% at 14 days; 36.76% at 28 days). Compared to Group 2, Group 3 had a significantly increased mortality risk (14-day adjusted HR =1.93, 95% confidence interval: 1.40-2.65, P<0.001; 28-day adjusted HR 1.76, 95% confidence interval 1.35-2.31, P<0.001). Kaplan-Meier analysis confirmed that Group 3 had the lowest survival probability (P<0.001). The associations remained consistent across sex, age, and glycemic subgroups (P for interaction >0.05). Conclusions: Distinct BUNCR trajectories may serve as independent prognostic indicators for 14-day and 28-day all-cause mortality in critically ill pneumonia patients requiring IMV. These findings could help identify high-risk patients who require closer clinical monitoring, while the formal clinical utility of BUNCR trajectory assessment requires further validation in prospective studies.
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