Prognostic Value of BUN/Albumin Ratio in Acute Upper Gastrointestinal Tract Haemorrhage
Abstract
Objectives: Acute upper gastrointestinal (GI) haemorrhage is a life-threatening condition with significant morbidity and mortality. Although risk stratification tools such as AIMS65 and Glasgow-Blatchford Score (GBS) are widely used, there is growing interest in biochemical markers that are easy to calculate and may aid clinical decision-making. This study aimed to investigate the prognostic value of the blood urea nitrogen (BUN)/albumin ratio (BAR) in predicting mortality in patients presenting with acute upper GI haemorrhage and to compare its performance with the AIMS65 and GBS scores.
Methods: This retrospective observational study included 356 adult patients admitted to a tertiary emergency department with a diagnosis of acute upper GI haemorrhage between January 2020 and October 2023. Patients with malignancy, liver or renal failure, sepsis, or incomplete records were excluded. Demographic, clinical, and laboratory data were collected. BAR and AIMS65 scores were calculated from initial laboratory results. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) analyses were performed to compare the predictive abilities of BAR, AIMS65, and GBS.
Results: The mean age of the study population was 67.25 ± 16.78 years, and 40.7% were female. The overall in-hospital mortality rate was 18.7%. The mean BAR was 1.45 ± 1.15. ROC analysis demonstrated that the AIMS65 score had a significantly better predictive ability for mortality than BAR (AUC difference p = 0.002). Similarly, GBS outperformed BAR in predicting discharge status (AUC difference p < 0.001). While BAR showed some correlation with mortality, it did not exhibit sufficient predictive power to replace established scoring systems.
Conclusion: Although the BUN/albumin ratio is an accessible and easily calculable biomarker with theoretical relevance in acute upper GI haemorrhage, this study found that its prognostic utility is inferior to AIMS65 and GBS. BAR alone should not be used in place of established clinical risk scores. However, given its simplicity and cost-effectiveness, further multicentre prospective studies are warranted to explore its role as a supportive prognostic tool in specific patient subgroups.
Keywords
Upper gastrointestinal bleeding, BUN/albumin ratio, AIMS65, Prognostic biomarkers, Emergency medicine, Emergency medicine
Ethical Statement
Ethical approval for this study was obtained from the İzmir Katip Çelebi University Ethics Committee (Protocol No: 0097).
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