Blood urea nitrogen-to-albumin ratio predicts mortality in acute graft-versus- host disease after allogeneic stem cell transplantation.

Authors

Gangping Li, Di Zhang, Minghui Li, Yongqi Wang, Fangfang Yuan, Jian Zhou, Yuewen Fu

Published in

Frontiers in immunology. Volume 17. Pages 1796065. Epub Jul 16, 2026.

Abstract

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.
This study aimed to evaluate the prognostic significance of BAR levels in patients developing aGVHD following allo-HSCT.
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.
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 p>0.05). Sensitivity analyses confirmed robustness of these associations.
Elevated BAR levels independently predict increased mortality in allo-HSCT recipients with aGVHD, suggesting its utility as a pragmatic prognostic biomarker requiring prospective validation.

PMID:
42534738
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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