Abstract Number: Esoc2026a1990 Influence of Admission Urea to Creatinine Ratio in Ischemic Stroke Patients’ Neurological Outcomes: A Systematic Review and Meta-Analysis

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 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 neurological prognostic factor. Our outcome of interest was Adverse Neurological Outcomes (AOS) characterized as modified Rankin score 2 in 3 months. Studies limited to specificsubgroups, including patients 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 6 studies eligible for our inclusion criteria. AOS was reported in 4 studies with a total sample size of 16184 patients. Estimated high BUN/Cr ratio was predefined as 20 in one study including 5971 patients, and calculated between 21.59 to 24.3 in the remaining studies with a sample size of 10213 patients. In both methods, an elevated BUN/Cr ratio was associated with a significant increase in AOS (sum aOR: 1.20, CI: 1.10-1.32). Conclusions This meta-analysis identified elevated BUN/Cr ratio as an independent risk factor for adverseneurological outcome in patients with ischemic stroke. Conflict of interest Rasa Beheshti: nothing to disclose