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 Da Silva, Joao, Metcalf, Anthony K., Mamas, Mamas A., Potter, John F. and Myint, Phyo K. (2024) Serum albumin and post-stroke outcomes: Analysis of UK regional registry data, systematic review, and meta-analysis. Nutrients, 16 (10). ISSN 2072-6643

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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.

Item Type:	Article
Additional Information:	Data Availability Statement: Data are contained within the article and Supplementary Materials (https://www.mdpi.com/2072-6643/16/10/1486#app1-nutrients-16-01486). Funding information: R.J.T. received the Innes Will Research Scholarship funded by the Aberdeen Clinical Academic Pathway Programme to carry out this research. This paper represents independent research partially funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care (BC).
Uncontrolled Keywords:	ischaemic stroke,albumin,long-term mortality,in-hospital outcomes,nutritional
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Depositing User:	LivePure Connector
Date Deposited:	15 May 2024 16:30
Last Modified:	15 May 2024 16:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/95214
DOI:	10.3390/nu16101486

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