ABSTRACT NUMBER: ESOC2026A2374 ASSOCIATION OF ADMISSION UREA TO CREATININE RATIO TO THE MORTALTY IN HEMORRHAGIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims We sought to evaluate existing evidence on the association between the admission blood urea nitrogen–to–creatinine (BUN/Cr) ratio and mortality in patients with hemorrhagic stroke Methods PubMed, Web of science, and Embase, were searched from the inception to July 2025. We included studies that assessing spontaneous intracranial hemorrhage (ICH) or hemorrhagic stroke patients’ admission BUN/Cr ratio who admitted to the hospital during 7 days after onset of symptoms and its association to the mortality. The primary outcome was in-hospital mortality or 30-day mortality. Studies evaluating patients with subarachnoid hemorrhage, non-English papers, case reports, reviews, letters, commentaries, and conference abstracts were excluded. We used QUIPS tool to evaluate risk of bias in finally included studies. We used Adjusted Odd Ratio (aOR) for multivariable analysis with 95% confidence interval (CI) to pool into the meta-analysis. Results Five eligible studies encompassing 89,415 patients with spontaneous ICH were included. A high BUN/Cr ratio was predefined as >15 or >20 in two studies including 85,880 patients, while the remaining studies (n = 3,535) reported calculated ratios ranging from 10.46 to 39.17. Elevated admission BUN/Cr ratio showed a modest but statistically significant association with increased mortality in adjusted analyses (pooled aOR: 1.02; 95% CI: 1.01–1.03). Conclusions Elevated admission BUN/Cr ratio may serve as a readily available prognostic marker for mortality in patients with hemorrhagic stroke. Conflict of interest sana aftabi: Nothing to disclose