Serum albumin and post stroke outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-analysis

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

doi:10.3390/nu16101486

Serum albumin and post stroke outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-analysis

Rosa J. Thuemmler^* (Corresponding Author), Tiberiu Alexandru Pana, Ben Carter, Ribeya Mahmood, Joao H Bettencourt, Anthony K Metcalf, Mamas A Mamas, John F Potter, Phyo Kyaw Myint

^*Corresponding author for this work

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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
Article number	1486
Number of pages	13
Journal	Nutrients
Volume	16
Issue number	10
Early online date	14 May 2024
DOIs	https://doi.org/10.3390/nu16101486
Publication status	Published - 14 May 2024

Bibliographical note

Acknowledgments
We would like to acknowledge the Norfolk and Norwich Stroke and TIA Register for providing the data. We would also like to acknowledge the valuable input of Melanie Bickerton, the University of Aberdeen Medical Library, for ensuring a comprehensive and well-designed search strategy.

Data Availability Statement

Data are contained within the article and Supplementary Materials.

Keywords

ischaemic stroke
albumin
long-term mortality
in-hospital outcomes
nutritional

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Cite this

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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.",

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T2 - Analysis of UK Regional Registry Data, Systematic Review, and Meta-analysis

AU - Thuemmler, Rosa J.

AU - Pana, Tiberiu Alexandru

AU - Carter, Ben

AU - Mahmood, Ribeya

AU - Bettencourt, Joao H

AU - Metcalf, Anthony K

AU - Mamas, Mamas A

AU - Potter, John F

AU - Myint, Phyo Kyaw

N1 - Acknowledgments We would like to acknowledge the Norfolk and Norwich Stroke and TIA Register for providing the data. We would also like to acknowledge the valuable input of Melanie Bickerton, the University of Aberdeen Medical Library, for ensuring a comprehensive and well-designed search strategy.

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N2 - 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.

AB - 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.

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KW - albumin

KW - long-term mortality

KW - in-hospital outcomes

KW - nutritional

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DO - 10.3390/nu16101486

M3 - Article

SN - 2072-6643

VL - 16

JO - Nutrients

JF - Nutrients

IS - 10

M1 - 1486

ER -

Serum albumin and post stroke outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-analysis

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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Cite this