ArticleFrontiers in immunology2026
Blood urea nitrogen-to-albumin ratio predicts mortality in acute graft-versus- host disease after allogeneic stem cell transplantation.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Evidence regarding the association between the blood urea nitrogen to albumin ratio (BAR) and clinical outcomes in acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains limited. Objective: This study aimed to evaluate the prognostic significance of BAR levels in patients developing aGVHD following allo-HSCT. Methods: We performed a retrospective cohort analysis of allo-HSCT recipients at Henan Cancer Hospital (January 2019-December 2024). Eligible participants were diagnosed with aGVHD during post-transplantation follow-up. Demographic characteristics, BAR measurements, and clinical outcomes were extracted from electronic medical records. Primary endpoints comprised all-cause mortality (ACM) and non-relapse mortality (NRM). Multivariable Cox proportional hazards models with confounder adjustment and subgroup analyses were employed to assess mortality associations. Results: Among 109 included patients (mean age 29.4 ± 15.3 years), 51 presented with grade I-II aGVHD and 58 with grade III-IV aGVHD. During the 30-month follow-up, 69 deaths, 3 relapse/progression events, and 37 survivors were documented. Elevated BAR (continuous) independently predicted increased all-cause mortality (ACM) (HR=5.92, 95% CI 1.66-9.16; p=0.006) and non-relapse mortality (NRM) (HR=5.26, 95% CI 1.48-8.71; p=0.010). Tertile analysis (T3 vs. T1) showed higher ACM (HR=2.19, 95% CI 1.05-4.57; p=0.037) and NRM (HR=2.07, 95% CI 1.01-4.22; p=0.046), with significant dose-response trends (p<0.05). Kaplan-Meier analysis confirmed inferior survival in high-BAR groups (OS p=0.0091; RFS p=0.015). Subgroup analyses demonstrated consistent effects across age, sex, conditioning regimens, graft types, and ABO compatibility (interaction Conclusion: Elevated BAR levels independently predict increased mortality in allo-HSCT recipients with aGVHD, suggesting its utility as a pragmatic prognostic biomarker requiring prospective validation.
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