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

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

doi:10.3390/nu16101486

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

Nutrients. 2024 May 14;16(10):1486. doi: 10.3390/nu16101486.

Authors

Rosa J Thuemmler¹, Tiberiu A Pana², Ben Carter³, Ribeya Mahmood¹, Joao H Bettencourt-Silva⁴, Anthony K Metcalf⁵, Mamas A Mamas⁶, John F Potter⁴, Phyo K Myint¹

Affiliations

¹ Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK.
² Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK.
³ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London WC2R 2LS, UK.
⁴ Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
⁵ Stroke Research Group, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK.
⁶ Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent ST5 5BG, UK.

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 (HR_max; 95% CI = 2.01; 1.61-2.49) and in-hospital mortality (RR_max; 95% CI = 1.48; 1.21-1.80). Albumin > 44 g/L associated with up to 12% higher long-term mortality (HR_max1.12; 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.

Keywords: albumin; in-hospital outcomes; ischaemic stroke; long-term mortality; nutritional.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Aged
Aged, 80 and over
Female
Hospital Mortality*
Humans
Hypoalbuminemia / epidemiology
Hypoalbuminemia / mortality
Ischemic Stroke / blood
Ischemic Stroke / epidemiology
Ischemic Stroke / mortality
Length of Stay / statistics & numerical data
Male
Middle Aged
Registries*
Serum Albumin* / analysis
Stroke / epidemiology
Stroke / mortality
United Kingdom / epidemiology

Substances

Serum Albumin