Association of Blood Urea Nitrogen to Serum Albumin Ratio with the Need for Non-invasive Ventilation in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of chronic morbidity and mortality, with frequent exacerbations that can lead to acute respiratory failure. Non-invasive ventilation (NIV) is a key treatment for acute respiratory failure in COPD exacerbations. The Blood Urea Nitrogen (BUN) to serum albumin ratio has been proposed as a prognostic marker in various diseases, reflecting metabolic stress and systemic inflammation. Still, its association with the need for NIV in COPD exacerbations has not been widely studied.

Objective: This study aims to evaluate the association between the BUN/Albumin ratio and the need for NIV in patients with exacerbations of COPD.

Methods: This cross-sectional study was conducted in the inpatient Department of Respiratory Medicine at the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh, from June 2023 to December 2024. A total of 116 patients diagnosed with exacerbations of COPD were enrolled. The BUN/Albumin ratio was measured for each patient, and the need for NIV was assessed. Data were analysed to determine if there was a significant association between the BUN/Albumin ratio and the requirement for NIV.

Results: The mean BUN/Albumin ratio was significantly higher in patients who required NIV (9.1±2.8) compared to those who did not (5.3±1.8, p = 0.001). A progressive increase in the BUN/Albumin ratio was observed with worsening severity of COPD exacerbations, with severe cases showing the highest ratios (9.5±2.9). Multivariate regression analysis showed that the BUN/Albumin ratio was significantly associated with the need for NIV (adjusted OR 19.629, 95% CI 13.976-27.561, p = 0.001).

Conclusion: The BUN/Albumin ratio is significantly associated with the need for NIV in patients with exacerbations of COPD. Elevated BUN/Albumin ratios may serve as a useful biomarker for identifying patients at higher risk for respiratory failure and may help guide early intervention in clinical practice.

Chest Heart J. 2025; 49(1) : 3-9