BUN/albumin ratio (BAR) has a better prognostic predictor than other laboratory makers in severe COVID-19 patients with heart failure

Type of funding sources: Public hospital(s). Main funding source(s): Dr. Soetomo General Hospital, Surabaya, Indonesia

Abbott

Heart failure (HF) is a common comorbidity in critically ill COVID-19 patients admitted to the intensive care unit (ICU) and it carries an extremely poor prognosis. COVID-19 has been described as a thrombo-inflammatory syndrome that may be related to myocardial damage. There are shared cardiovascular comorbidities and pathophysiology between HF and COVID-19 severity.

The study aimed to investigate the relationship between the laboratory markers and the prognosis of COVID-19 patients with HF admitted to the ICU.

We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021. Subjects of this study were recruited according to WHO criteria for severe COVID-19 and ESC criteria for HF who admitted to ICU. Blood samples were taken to measure hs-Troponin, NT-proBNP, Neutrophil to Lymphocyte Ratio (NLR), BUN/albumin ratio (BAR), and D-dimer/fibrinogen ratio (DFR). Subjects were then followed to assess in-hospital mortality and 90-day mortality.

A total of 43 subjects were included in this study. This research showed that severe COVID-19 patients, who have mortality events at any cause, have significantly higher hs-Troponin, NT-proBNP, NLR, BAR, and DFR (P-value 0.022, 0.027, 0.029, <0.001, and 0.032 respectively). Pairwise comparison of receiver operating characteristic (ROC) curves showed that BAR was better at predicting mortality outcome (Area under curve 0.849, 95% CI 0.732-0.966, P-value <0.001). Multiple COX regression analyses found a relationship between BAR and all-cause mortality at 90-day follow-up (HR 1.306, 95% CI 1.004–1.069, P-value= 0.026). Kaplan-Meier also showed similar results as well (P-value 0.001).

Increasing hs-Troponin, NT-proBNP, NLR, BAR, and DFR are associated with increased mortality among severe COVID-19 patients with HF. However, BAR is the best predictor for mortality events in severe COVID-19 patients with HF.