Serum Albumin and Post-Stroke Outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis

Thuemmler, Rosa J.; Pana, Tiberiu A.; Carter, Ben; Mahmood, Ribeya; Bettencourt-Silva, Joao H.; Metcalf, Anthony K.; Mamas, Mamas A.; Potter, John F.; Myint, Phyo K.

Abstract

Hypoalbuminemia associates with poor acute ischemic stroke (AIS) outcomes. We hypothesised a non-linear relationship and aimed to systematically assess this association using prospective stroke data from the Norfolk and Norwich Stroke and TIA Register. Consecutive AIS patients aged ≥40 years admitted December 2003–December 2016 were included. Outcomes: In-hospital mortality, poor discharge, functional outcome (modified Rankin score 3–6), prolonged length of stay (PLoS) > 4 days, and long-term mortality. Restricted cubic spline regressions investigated the albumin–outcome relationship. We updated a systematic review (PubMed, Scopus, and Embase databases, January 2020–June 2023) and undertook a meta-analysis. A total of 9979 patients were included; mean age (standard deviation) = 78.3 (11.2) years; mean serum albumin 36.69 g/L (5.38). Compared to the cohort median, albumin < 37 g/L associated with up to two-fold higher long-term mortality (HRmax; 95% CI = 2.01; 1.61–2.49) and in-hospital mortality (RRmax; 95% CI = 1.48; 1.21–1.80). Albumin > 44 g/L associated with up to 12% higher long-term mortality (HRmax1.12; 1.06–1.19). Nine studies met our inclusion criteria totalling 23,597 patients. Low albumin associated with increased risk of long-term mortality (two studies; relative risk 1.57 (95% CI 1.11–2.22; I2 = 81.28)), as did low-normal albumin (RR 1.10 (95% CI 1.01–1.20; I2 = 0.00)). Strong evidence indicates increased long-term mortality in AIS patients with low or low-normal albumin on admission.

Citation

Thuemmler, R. J., Pana, T. A., Carter, B., Mahmood, R., Bettencourt-Silva, J. H., Metcalf, A. K., …Myint, P. K. (in press). Serum Albumin and Post-Stroke Outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis. Nutrients, 16(10), Article 1486. https://doi.org/10.3390/nu16101486

• Journal Article Type: Article
• Acceptance Date: May 8, 2024
• Online Publication Date: May 14, 2024
• Deposit Date: May 28, 2024
• Journal: Nutrients
• Electronic ISSN: 2072-6643
• Publisher: MDPI
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 10
• Article Number: 1486
• DOI: https://doi.org/10.3390/nu16101486
• Keywords: ischaemic stroke; albumin; long-term mortality; in-hospital outcomes; nutritional
• Public URL: https://keele-repository.worktribe.com/output/833354