Comparison of the Predictive Power of Blood Urea Nitrogen/Albumin, Lactate/Albumin, and C-reactive Protein/Albumin Ratios for Prognosis of Mortality in Critically Ill Geriatric Patients in the Emergency Department
Journal of Emergency Medicine, cilt.79, ss.336-348, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 79
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.jemermed.2025.08.031
- Dergi Adı: Journal of Emergency Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.336-348
- Anahtar Kelimeler: Emergency services, Geriatrics, Older, Mortality, Prognosis, Biomarkers
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background Critically ill geriatric patients presenting to the emergency department have high mortality rates. Identifying reliable biomarkers that predict short-term mortality in this population is crucial for risk stratification and clinical decision-making. Objective To compare the prognostic utility of blood urea nitrogen (BUN)/albumin, lactate/albumin, and C-reactive protein (CRP)/albumin ratios in predicting short-term mortality in critically ill geriatric patients. Methods This retrospective cohort study included patients aged 65 years or older who required inotropic support in the emergency department. Patients with incomplete laboratory or mortality data were excluded. The primary outcome was 30-day all-cause mortality; the secondary outcome was 7-day mortality. Prognostic performance of biochemical ratios was assessed using ROC curve analysis and multivariate logistic regression models. Results A total of 147 patients were analyzed, with a 30-day mortality rate of 51%. All three ratios were significantly higher among nonsurvivors. The lactate/albumin ratio showed the highest predictive value (AUC = 0.852), followed by BUN/albumin (AUC = 0.762) and CRP/albumin (AUC = 0.729). Each ratio independently predicted 30-day mortality after adjustment for confounders. Pairwise AUC comparisons showed that the lactate/albumin ratio had significantly better performance than the CRP/albumin ratio ( p = 0.014). All three ratios were significantly higher among nonsurvivors at both 7-day and 30-day mortality endpoints ( p < 0.001 for all). In multivariate logistic regression analyses, the lactate/albumin ratio (OR: 2.47; 95% CI: 1.52–4.01), BUN/albumin ratio (OR: 1.91; 95% CI: 1.19–3.07), and CRP/albumin ratio (OR: 1.76; 95% CI: 1.10–2.84) independently predicted 30-day mortality after adjustment for potential confounders. Conclusion The lactate/albumin, BUN/albumin, and CRP/albumin ratios were all independently associated with short-term mortality in geriatric patients requiring inotropic support. Among them, the lactate/albumin ratio demonstrated the strongest prognostic value. These markers may support early risk stratification and guide clinical decision-making in the emergency setting.