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.
Original language | English |
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Article number | 1486 |
Journal | Nutrients |
Volume | 16 |
Issue number | 10 |
DOIs | |
Publication status | Published - 14 May 2024 |
Keywords
- ischaemic stroke
- albumin
- long-term mortality
- in-hospital outcomes
- nutritional