Clinic Value of Blood Urea to Creatinine Ratio in Heart Failure Patients: A Systematic Review

Aims: To synthesize the existing evidence on the association of BCR with clinical outcomes in patients with heart failure. Methods: A comprehensive and systematic search of observational studies was conducted across five major databases—PubMed, Embase, Scopus, Web of Science, and Google Scholar—covering all records up to February 2024. The primary outcomes of interest included mortality, rehospitalization, cardiovascular events, and renal complications. To evaluate the methodological quality, the Newcastle–Ottawa scale was applied, allowing for the structured assessment of bias across the selection, comparability, and outcome domains. Additionally, the certainty of the evidence was appraised using the GRADE framework. Results: Twenty studies including 21 397 HF patients were analyzed. For ≥ 1-year mortality (11 661 participants, 11 studies), hazard ratios ranged from 1.30 to 2.19, with the strongest association in HF with preserved ejection fraction (HR: 3.28, 95% CI: 2.00–5.38) with very low certainty. It also correlated with worse NYHA class IV versus II (MD: 12.03, 95% CI: 10.54–13.52) and increased risk of 1-month major adverse cardiovascular events (OR: 2.47, 95% CI: 1.01–6.01), both with very low certainty. Most included cohort studies were rated as low risk of bias, with only two studies at moderate risk and one study at high risk. Conclusion: Elevated BCR is associated with adverse outcomes in patients with heart failure. However, its discriminative performance appears limited, and its incremental value over established biomarkers such as NT-proBNP remains unclear. Further prospective studies are required to determine its clinical utility.