Abstract Number: Esoc2026ys228 Association of Admission Urea to Creatinine Ratio to the Mortalty in Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract Background and aims We aimed to sum and evaluate the evidence assessingthe association of admission urea to creatinine (BUN/Cr) ratio to the mortality in ischemic stroke patients. 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 who admitted to the hospital during 7 days after onset of symptoms and its association to the mortality. The primary outcome was in-hospitalmortality or 30-day mortality. Studies limited to specific subgroups, including patients receiving intravenous thrombolysis or endovascular thrombectomy were excluded. We used QUIPS tool to evaluate risk of bias in finally included studies. We used both Adjusted Odd Ratio (aOR) for multivariable analysis and unadjusted OR with 95% confidence interval (CI) to pool into the meta-analysis. Results After selection of database results, we found 6 studies eligible for our inclusion criteria. Four studies comprising of 15032 patients reported non-adjusted OR while 3 studies with a total sample size of 10865 patients reported aOR. Estimated high BUN/Cr ratio was predefined as 15 or 30 in two studies involving8541 patients, and calculated and ranged between21.59 to 24.3 in the remaining studies with a sample size of 9846 patients. An elevated BUN/Cr ratio was significantly associated with increased Mortality in adjusted analysis (pooled aOR: 1.32, CI: 1.09-1.60) butthis association was not observed in unadjusted analysis (pooled OR: 1.04, CI: 1.00-1.08). Conflict of interest Rasa Beheshti: nothing to disclose