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

Grants and funding

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).