A Comparison of BUN/Albumin Ratio with PSI and CURB-65 for Predicting Mortality in COVID-19 Pneumonia in the Emergency Department

Abstract

Introduction:The coronavirus disease-2019 (COVID-19) pandemic was the leading cause of high mortality and morbidity in the previous two years. Rapid determination of the severity of the disease is important in terms of reducing the intensity and initiating effective treatment. Although the pneumonia severity index (PSI) and CURB-65 classifications are widely employed to predict mortality and morbidity in patients diagnosed with pneumonia, biomarkers predicting the mortality and severity of COVID-19 in the emergency department (ED) are also needed. This study investigated the relationship between the blood urea nitrogen (BUN)/albumin ratio (BAR) and mortality and disease severity.Methods:Five hundred eighty-one patients presenting to the ED between March 2020 and January 2022 and diagnosed with COVID pneumonia were included in this observational study. Patients’ BUN and albumin levels, and PSI and CURB-65 scores were calculated, and in-hospital mortality was recorded. The power of BAR in predicting mortality was compared with that of PSI and CURB-65 by using statistical analysis.Results:A significant association was determined between increased BAR and mortality. The area under the curve (AUC) value of BAR was 0.684, with 76.6% selectivity and 53.4% sensitivity at a cut-off point of 6.85. The CURB-65 score AUC value was 0.571, with 56% selectivity and 55.9% sensitivity at a cut-off point of 1.5. The AUC value for the PSI score was 0.609, with 63.3% selectivity and 50.3% sensitivity at a cut-off point of 107.5.Conclusion:BAR is a simple but independent marker of mortality and severity in COVID-19 viral pneumonia.

Keywords

• bun/albumin ratio
• emergency department
• covid-19
• mortality