Constructing and validating a nomogram incorporating blood urea nitrogen/albumin ratio to predict prognosis of heart failure in the elderly

Background With the aging of population, the prevalence of heart failure (HF) is on the rise, and exploring risk stratification markers and prognostic models for elderly patients with HF is important for improving prognosis.

Objective To investigate association of blood urea nitrogen to albumin ratio (BAR) with death within 1 year in elderly patients with heart failure, and then propose a nomogram including BAR, verifying its predictive value.

Methods Training set data were obtained from 1 259 elderly patients diagnosed with heart failure from January 2016 to October 2021 in Chinese PLA General Hospital, and the validation set data were obtained from 314 elderly patients diagnosed with heart failure from October 2021 to October 2022. Logistic regression analysis was used to screen risk factors and construct the nomogram based on risk factors; ROC curves, calibration curves, and clinical decision curve analysis (DCA) were used to assess model discrimination, consistency, and clinical benefit; The performance of the nomogram was compared with that of N-terminal brain natriuretic peptide precursor (NT-proBNP) and the BIOSTAT-CHF prediction model by calculating the area under the ROC curve and DCA.

Results In the training cohort, 27.2% (343 out of 1 259) patients died within 1 year, while in the validation cohort, 25.2% (79 out of 314) patients died within the same timeframe. Multivariate Logistic regression showed that age, D-dimer, NT-proBNP, BAR, and ACEI/ARB use independently associated with mortality (P<0.05). The nomogram was constructed based on these five factors, which demonstrated good discrimination ability (AUC=0.838, P<0.001), consistency (Hosmer-Lemeshow χ²=4.251, P=0.834), and clinical benefit. And the predictive efficacy of the nomogram was better compared with both NT-proBNP and the European BIOSTAT-CHF prediction model (0.838 vs 0.703 and 0.825, both P<0.05). The DCA results suggested that the nomogram added more net benefit than both the NT-proBNP and the BIOSTAT-CHF prediction model.

Conclusion BAR is an independent predictor of death within 1 year in elderly patients with heart failure. The nomograms with BAR demonstrate excellent discrimination and calibration ability, providing strong support for prognostic assessment.