Abstract Background and aims We aimed to give a comprehensive review of studies evaluating prognostic value of admission urea to creatinine (BUN/Cr) ratio in ischemic stroke patients in terms of short term and in hospital assessed neurological function. Methods PubMed, Web of science, and Embase, were searched from the inception to July 2025. We included studies that assessing ischemic stroke patients’ admission BUN/Cr ratio as the short term neurological prognostic factor. Our outcome of interest was Early Neurological Deterioration (END) defined as the increase of 3 or more points in the National Institutes of Health Stroke Scale within 3 days. Studies evaluating only special subgroup of patients including subjects receiving intravenous thrombolysis or endovascular thrombectomy, 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 chose Adjusted Odd Ratio (aOR) for multivariable analysis with 95% confidence interval (CI) as the effect measure to pool into the meta-analysis. Results After selection of database results, we found 2 studies eligible for our inclusion criteria. END was reported in 2 studies with sample size of 310 patients. Estimated high BUN/Cr ratio was predefined as above 15 in both studies. An elevated BUN/Cr ratio was associated with a significant increase in END (sum aOR: 4.04, CI: 1.10-1.32). Conclusions In this study, we found the elevation of the BUN/Cr ratio as an independent risk factor of short term neurological adverse outcome in ischemic stroke patients during hospital admission setting. Conflict of interest Rasa beheshti:nothing to disclose
Beheshti et al. (2026) studied this question.