Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction

Ahmet Genç; Gülsüm Meral Yılmaz Öztekin; Şükriye Uslu; Rauf Avcı

Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction

Abstract

Aims: This study evaluated the prognostic value of several novel laboratory-derived indices: red blood cell distribution width (RDW), blood urea nitrogen-to-albumin ratio (BAR), Systemic Immune-Inflammation Index (SII), Model for End-Stage Liver Disease excluding the international normalized ratio (MELD-XI), uric acid-to-albumin ratio (UAR), and estimated plasma volume status (ePVS) in patients with heart failure with reduced ejection fraction (HFrEF). Their incremental contributions beyond conventional risk factors were compared. Methods: This retrospective single-center study included 1.314 patients with HFrEF. RDW, BAR, SII, MELD-XI, UAR, and ePVS were each added separately to a fixed reference model including age, left ventricular ejection fraction (LVEF), log10 transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA) functional class, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitor (ARNI) use, beta-blocker use, mineralocorticoid receptor antagonist (MRA) use, and loop diuretic use. Age and LVEF were modeled with restricted cubic splines. Prognostic performance was assessed using Harrell’s concordance index (C-index), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), with bootstrap internal validation and 3-year calibration. Results: During follow-up, 428 patients (32.6%) died from all causes. Among the evaluated biomarkers, addition of log10transformed BAR produced the largest improvement in discrimination, increasing the C-index from 0.7489 (95% CI: 0.7256-0.7725) to 0.7585 (95% CI: 0.7355-0.7816), with a paired ΔC-index of 0.0096 (95% CI: 0.0021-0.0168). Bootstrap internal validation showed that BAR was the most frequently selected biomarker, although the optimism-corrected incremental improvement remained modest. Kaplan-Meier analysis demonstrated progressively worse survival across increasing L_BAR quartiles (log-rank p<0.001). Conclusion: In this cohort, BAR showed the largest incremental improvement in discrimination among the evaluated laboratory derived biomarkers, although the absolute gain was modest. Its low cost and routine availability support further evaluation as a complementary prognostic marker; however, external prospective validation and evidence of clinical utility are required before its incorporation into risk-guided management strategies.

Keywords

References

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Details

Primary Language

English

Subjects

Cardiology

Journal Section

Research Article

Authors

Ahmet Genç ^*
0000-0003-0797-8418
Türkiye

Gülsüm Meral Yılmaz Öztekin
0000-0001-9540-5075
Türkiye

Şükriye Uslu
0000-0001-7504-7637
Türkiye

Rauf Avcı
0000-0002-8453-205X
Türkiye

Publication Date

October 25, 2026

Submission Date

July 7, 2026

Acceptance Date

September 8, 2026

Published in Issue

Year 2026 Volume: 8 Number: 6

IZ

https://izlik.org/JA77YF47GP

Cite

RIS / Bibtex

APA

Genç, A., Yılmaz Öztekin, G. M., Uslu, Ş., & Avcı, R. (2026). Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction. Anatolian Current Medical Journal, 8(6), 1279-1290. https://izlik.org/JA77YF47GP

AMA

1.Genç A, Yılmaz Öztekin GM, Uslu Ş, Avcı R. Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction. Anatolian Curr Med J / ACMJ / acmj. 2026;8(6):1279-1290. https://izlik.org/JA77YF47GP

Chicago

Genç, Ahmet, Gülsüm Meral Yılmaz Öztekin, Şükriye Uslu, and Rauf Avcı. 2026. “Prognostic Value of the Blood Urea Nitrogen to Albumin Ratio in Patients With Heart Failure With Reduced Ejection Fraction”. Anatolian Current Medical Journal 8 (6): 1279-90. https://izlik.org/JA77YF47GP.

EndNote

Genç A, Yılmaz Öztekin GM, Uslu Ş, Avcı R (October 1, 2026) Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction. Anatolian Current Medical Journal 8 6 1279–1290.

IEEE

[1]A. Genç, G. M. Yılmaz Öztekin, Ş. Uslu, and R. Avcı, “Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 6, pp. 1279–1290, Oct. 2026, [Online]. Available: https://izlik.org/JA77YF47GP

ISNAD

Genç, Ahmet - Yılmaz Öztekin, Gülsüm Meral - Uslu, Şükriye - Avcı, Rauf. “Prognostic Value of the Blood Urea Nitrogen to Albumin Ratio in Patients With Heart Failure With Reduced Ejection Fraction”. Anatolian Current Medical Journal 8/6 (October 1, 2026): 1279-1290. https://izlik.org/JA77YF47GP.

JAMA

1.Genç A, Yılmaz Öztekin GM, Uslu Ş, Avcı R. Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction. Anatolian Curr Med J / ACMJ / acmj. 2026;8:1279–1290.

MLA

Genç, Ahmet, et al. “Prognostic Value of the Blood Urea Nitrogen to Albumin Ratio in Patients With Heart Failure With Reduced Ejection Fraction”. Anatolian Current Medical Journal, vol. 8, no. 6, Oct. 2026, pp. 1279-90, https://izlik.org/JA77YF47GP.

Vancouver

1.Ahmet Genç, Gülsüm Meral Yılmaz Öztekin, Şükriye Uslu, Rauf Avcı. Prognostic value of the blood urea nitrogen to albumin ratio in patients with heart failure with reduced ejection fraction. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Oct. 1;8(6):1279-90. Available from: https://izlik.org/JA77YF47GP